Provider Demographics
NPI:1992875462
Name:ORT, JANICE DALE (PSYD)
Entity type:Individual
Prefix:DR
First Name:JANICE
Middle Name:DALE
Last Name:ORT
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:375 E HORSETOOTH RD
Mailing Address - Street 2:BUILDING 2-203
Mailing Address - City:FORT COLLINS
Mailing Address - State:CO
Mailing Address - Zip Code:80525-3155
Mailing Address - Country:US
Mailing Address - Phone:970-377-9443
Mailing Address - Fax:970-204-6985
Practice Address - Street 1:375 E HORSETOOTH RD
Practice Address - Street 2:BUILDING 2-203
Practice Address - City:FORT COLLINS
Practice Address - State:CO
Practice Address - Zip Code:80525-3155
Practice Address - Country:US
Practice Address - Phone:970-377-9443
Practice Address - Fax:970-204-6985
Is Sole Proprietor?:No
Enumeration Date:2006-11-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO1606103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO07016066Medicaid
CO07016066Medicaid