Individual
SANDRA ORTIZ
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
ICADC
Contact information
Practice address
115 PIMA DRIVE, FORT HALL, ID 83203-0306
(208) 238-2400
(208) 238-5462
Mailing address
EAST AGENCY RD, FORT HALL, ID 83203
(208) 238-2400
(208) 238-5462
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
ICADC 22075
ID
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
003399100
—
ID
Enumeration date
07/11/2008
Last updated
07/11/2008
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