Provider Demographics
NPI:1861063208
Name:ORTEGA, EVELYN (CCC-MS, SLP)
Entity type:Individual
Prefix:
First Name:EVELYN
Middle Name:
Last Name:ORTEGA
Suffix:
Gender:F
Credentials:CCC-MS, SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3615 SPICER DR SE
Mailing Address - Street 2:
Mailing Address - City:ALBANY
Mailing Address - State:OR
Mailing Address - Zip Code:97322-7043
Mailing Address - Country:US
Mailing Address - Phone:541-967-7551
Mailing Address - Fax:
Practice Address - Street 1:1475 CAPITOL ST NE
Practice Address - Street 2:
Practice Address - City:SALEM
Practice Address - State:OR
Practice Address - Zip Code:97301-7850
Practice Address - Country:US
Practice Address - Phone:971-599-1712
Practice Address - Fax:888-835-4257
Is Sole Proprietor?:No
Enumeration Date:2021-07-07
Last Update Date:2022-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR016110235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist