MEDICARE: MRS. SUZANNE ELISE ORTIZ CCC-SLP

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	235Z00000X	Speech-Language Pathologist	1160	AZ

General Provider Information

NPI Number	:	1417125980
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. SUZANNE ELISE ORTIZ CCC-SLP

Provider Business Mailing Address
First Line	:	2050 N WILMOT RD
Second Line	:
City	:	TUCSON
State	:	AZ
Zip	:	85712-3039
Country	:	US
Telephone Number	:	520-721-4205
Fax Number	:

Provider Business Practice Location Address
First Line	:	2050 N WILMOT RD
Second Line	:
City	:	TUCSON
State	:	AZ
Zip	:	85712-3039
Country	:	US
Telephone Number	:	520-721-4205
Fax Number	:

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

Provider Enumeration Date	:	02/18/2008
Last Update Date	:	02/18/2008

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Directions to “ MRS. SUZANNE ELISE ORTIZ CCC-SLP” Practice Location

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