Healthcare Provider Details

I. General information

NPI: 1740036219
Provider Name (Legal Business Name): BRIANNE ALISA ORTEGA MS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/25/2024
Last Update Date: 04/25/2024
Certification Date: 04/25/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1770 SE FLEMING AVE
GRESHAM OR
97080-6397
US

IV. Provider business mailing address

1770 SE FLEMING AVE
GRESHAM OR
97080-6397
US

V. Phone/Fax

Practice location:
  • Phone: 503-261-4500
  • Fax:
Mailing address:
  • Phone: 503-261-4500
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number012464
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: