Provider Demographics
NPI:1619158573
Name:ORTIZ, ALICIA (SLP)
Entity Type:Individual
Prefix:
First Name:ALICIA
Middle Name:
Last Name:ORTIZ
Suffix:
Gender:F
Credentials:SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14722 SW 90TH TER
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33196-1465
Mailing Address - Country:US
Mailing Address - Phone:305-439-0744
Mailing Address - Fax:305-383-6351
Practice Address - Street 1:14722 SW 90TH TER
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33196-1465
Practice Address - Country:US
Practice Address - Phone:305-439-0744
Practice Address - Fax:305-383-6351
Is Sole Proprietor?:No
Enumeration Date:2007-11-20
Last Update Date:2007-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSA 871235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist