Provider Demographics
NPI:1992221691
Name:ORTIZ, JASMINE ALEXANDRA
Entity Type:Individual
Prefix:
First Name:JASMINE
Middle Name:ALEXANDRA
Last Name:ORTIZ
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 1:3119 CLOISTER LN
Mailing Address - Street 2:
Mailing Address - City:DAYTON
Mailing Address - State:OH
Mailing Address - Zip Code:45449-3505
Mailing Address - Country:US
Mailing Address - Phone:513-571-9592
Mailing Address - Fax:
Practice Address - Street 1:4128 CEDAR RIDGE RD
Practice Address - Street 2:
Practice Address - City:DAYTON
Practice Address - State:OH
Practice Address - Zip Code:45414-3908
Practice Address - Country:US
Practice Address - Phone:513-571-9592
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-08-15
Last Update Date:2017-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist