Individual
MRS. BRENDA MARIE ORTLUND
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
B.S.
Contact information
Practice address
514 W WADE LN, PAYSON, AZ 85541-4886
(928) 472-5800
Mailing address
420 N GRAHAM RANCH RD, PAYSON, AZ 85541-4123
(928) 474-4278
Taxonomy
Speciality
Code
Description
License number
State
235Z00000X
Speech-Language Pathologist
Primary
SLP LO633
AZ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
688228
—
AZ
Enumeration date
01/23/2007
Last updated
07/08/2007
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