Healthcare Provider Details

I. General information

NPI: 1740106624
Provider Name (Legal Business Name): JULIE A ORTEGA M.A., CF-SLP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/25/2026
Last Update Date: 06/25/2026
Certification Date: 06/25/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6799 E TEXAS ST
BOSSIER CITY LA
71111-6931
US

IV. Provider business mailing address

6799 E TEXAS ST
BOSSIER CITY LA
71111-6931
US

V. Phone/Fax

Practice location:
  • Phone: 318-616-2336
  • Fax: 318-616-1857
Mailing address:
  • Phone: 318-616-2336
  • Fax: 318-616-1857

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number10189
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: