Healthcare Provider Details

I. General information

NPI: 1598476566
Provider Name (Legal Business Name): JENNIFER PATRICIA ORTEGA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/09/2022
Last Update Date: 12/09/2022
Certification Date: 12/07/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12300 WASHINGTON HIGHWAY ASHLAND
VIRGINIA VA
23005-2300
US

IV. Provider business mailing address

12300 WASHINGTON HIGHWAY ASHLAND
VIRGINIA VA
23005
US

V. Phone/Fax

Practice location:
  • Phone: 804-365-4222
  • Fax:
Mailing address:
  • Phone: 804-365-4222
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number0904014624
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: