Provider Demographics
NPI:1598476566
Name:ORTEGA, JENNIFER PATRICIA
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:PATRICIA
Last Name:ORTEGA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12300 WASHINGTON HIGHWAY
Mailing Address - Street 2:ASHLAND
Mailing Address - City:VIRGINIA
Mailing Address - State:VA
Mailing Address - Zip Code:23005
Mailing Address - Country:US
Mailing Address - Phone:804-365-4222
Mailing Address - Fax:
Practice Address - Street 1:12300 WASHINGTON HIGHWAY
Practice Address - Street 2:ASHLAND
Practice Address - City:VIRGINIA
Practice Address - State:VA
Practice Address - Zip Code:23005-2300
Practice Address - Country:US
Practice Address - Phone:804-365-4222
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-12-09
Last Update Date:2022-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA09040146241041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA1104858653Medicaid