Sandra Ortiz, ICADC
Individual provider Active NPI Addiction (Substance Use Disorder) Counselor · Fort Hall, ID
NPI 1396909024 · NPPES record last updated Jul 11, 2008
Key facts
- NPI
- 1396909024
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Addiction (Substance Use Disorder) Counselor 101YA0400X
- License
- ICADC 22075 (ID)
- Practice address
- 115 Pima Drive
Fort Hall, ID 83203-0306 - Phone
- (208) 238-2400
- Fax
- (208) 238-5462
- NPI assigned
- Jul 11, 2008
- Sex
- Female
- Sole proprietor
- No
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| ICADC 22075 | ID | MD | Addiction (Substance Use Disorder) Counselor |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Addiction (Substance Use Disorder) Counselor | 101YA0400X | ICADC 22075 | ID | Yes |
Addresses
Primary practice location
115 Pima Drive
Fort Hall, ID 83203-0306
Mailing address
East Agency Rd
Fort Hall, ID 83203
Phone (208) 238-2400
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 003399100 | Medicaid | ID |
Other providers in Fort Hall, ID
- Not Tsoo Gah Nee Indian Health
- Not Tsoo Gah Nee Indian Health Services
- Not-Tsoo Gah-Nee Indian Health Center
- Not-Tsoo Gah-Nee Indian Health Center Pharmacy
- Not-Tsoo Gah-Nee Indiane Health Services
- Kevin Pendlebury
- James Picanco Sr.
- Brandy Pugmire
- Nava Reneda
- Catherine Tammy Salisbury
All providers in Fort Hall, ID · Addiction (Substance Use Disorder) Counselor in Idaho
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jul 11, 2008. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.