Healthcare Provider Details

I. General information

NPI: 1952628711
Provider Name (Legal Business Name): KIMBERLY R ORTEGA M.S., CCC-SLP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: KIMBERLY R GIBSON

II. Dates (important events)

Enumeration Date: 05/03/2010
Last Update Date: 10/28/2024
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

620 N. ALLEGHANEY 620 N. ALLEGHANEY
ODESSA TX
79761
US

IV. Provider business mailing address

620 N. ALLEGHANEY 620 N. ALLEGHANEY
ODESSA TX
79761
US

V. Phone/Fax

Practice location:
  • Phone: 432-332-8244
  • Fax: 432-580-7428
Mailing address:
  • Phone: 432-332-8244
  • Fax: 432-580-7428

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number17594
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: