MEDICARE: EDNA EDITH ORTIZ BS SLP-A

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	2355S0801X	Speech-Language Assistant	36844	TX

General Provider Information

NPI Number	:	1407199300
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	EDNA EDITH ORTIZ BS SLP-A

Provider Business Mailing Address
First Line	:	6666 HARWIN DR STE 345
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77036-2261
Country	:	US
Telephone Number	:	713-429-1176
Fax Number	:	832-252-9263

Provider Business Practice Location Address
First Line	:	6666 HARWIN DR STE 345
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77036-2261
Country	:	US
Telephone Number	:	713-429-1176
Fax Number	:	832-252-9263

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/29/2013
Last Update Date	:	03/29/2013

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