MEDICARE: MS. JENNIFER ORTIZ

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	103K00000X	Behavior Analyst

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	:	1669877767
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. JENNIFER ORTIZ

Provider Business Mailing Address
First Line	:	41 W SUMMIT ST APT 54
Second Line	:
City	:	SOUTH HADLEY
State	:	MA
Zip	:	01075-2773
Country	:	US
Telephone Number	:	413-386-0101
Fax Number	:

Provider Business Practice Location Address
First Line	:	41 W SUMMIT ST APT 54
Second Line	:
City	:	SOUTH HADLEY
State	:	MA
Zip	:	01075-2773
Country	:	US
Telephone Number	:	413-386-0101
Fax Number	:

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

Provider Enumeration Date	:	10/31/2014
Last Update Date	:	06/20/2023

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