Provider Demographics
NPI:1518352475
Name:ORTIZ, IVANNA (MA, CCC-SLP)
Entity Type:Individual
Prefix:
First Name:IVANNA
Middle Name:
Last Name:ORTIZ
Suffix:
Gender:F
Credentials:MA, CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2153 CORAL WAY
Mailing Address - Street 2:602
Mailing Address - City:CORAL GABLES
Mailing Address - State:FL
Mailing Address - Zip Code:33145-2631
Mailing Address - Country:US
Mailing Address - Phone:305-856-1999
Mailing Address - Fax:305-856-7600
Practice Address - Street 1:2153 CORAL WAY
Practice Address - Street 2:602
Practice Address - City:CORAL GABLES
Practice Address - State:FL
Practice Address - Zip Code:33145-2631
Practice Address - Country:US
Practice Address - Phone:305-856-1999
Practice Address - Fax:305-856-7600
Is Sole Proprietor?:No
Enumeration Date:2015-03-30
Last Update Date:2015-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSA 13609235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist