MEDICARE: MRS. JACQUELINE M ORTEGA SLP-CCC

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	SLPL0821	AZ

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1093860140
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. JACQUELINE M ORTEGA SLP-CCC

Provider Business Mailing Address
First Line	:	5034 S WILD MARE RD
Second Line	:
City	:	TUCSON
State	:	AZ
Zip	:	85757-9246
Country	:	US
Telephone Number	:	520-883-6307
Fax Number	:

Provider Business Practice Location Address
First Line	:	5034 S WILD MARE RD
Second Line	:
City	:	TUCSON
State	:	AZ
Zip	:	85757-9246
Country	:	US
Telephone Number	:	520-883-6307
Fax Number	:

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

Provider Enumeration Date	:	01/25/2007
Last Update Date	:	07/09/2007

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Directions to “ MRS. JACQUELINE M ORTEGA SLP-CCC” Practice Location

Language	Start Address	Practice Location

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