Provider Demographics
NPI:1396335410
Name:ORTIZ, ASHLEY OLIVIA
Entity type:Individual
Prefix:
First Name:ASHLEY
Middle Name:OLIVIA
Last Name:ORTIZ
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12531 COURSEY BLVD APT 2092
Mailing Address - Street 2:
Mailing Address - City:BATON ROUGE
Mailing Address - State:LA
Mailing Address - Zip Code:70816-4586
Mailing Address - Country:US
Mailing Address - Phone:504-613-7954
Mailing Address - Fax:
Practice Address - Street 1:4315 BLUEBONNET BLVD STE B
Practice Address - Street 2:
Practice Address - City:BATON ROUGE
Practice Address - State:LA
Practice Address - Zip Code:70809-9661
Practice Address - Country:US
Practice Address - Phone:225-223-6968
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-01-22
Last Update Date:2021-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
104100000X
LA104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes104100000XBehavioral Health & Social Service ProvidersSocial WorkerGroup - Single Specialty