Provider Demographics
NPI:1750935060
Name:ORTIZ-MORALES, ELBANGELIS (MS CFY-SLP)
Entity type:Individual
Prefix:
First Name:ELBANGELIS
Middle Name:
Last Name:ORTIZ-MORALES
Suffix:
Gender:F
Credentials:MS CFY-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:470 WOODBARK CT
Mailing Address - Street 2:
Mailing Address - City:MAULDIN
Mailing Address - State:SC
Mailing Address - Zip Code:29662-3269
Mailing Address - Country:US
Mailing Address - Phone:787-245-5379
Mailing Address - Fax:
Practice Address - Street 1:319 GARLINGTON RD STE B5
Practice Address - Street 2:
Practice Address - City:GREENVILLE
Practice Address - State:SC
Practice Address - Zip Code:29615-4621
Practice Address - Country:US
Practice Address - Phone:864-361-4879
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-07-25
Last Update Date:2019-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC6948235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist