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NPI Code Detail

MEDICARE: NICOLE ORTIZ

MEDICARE: NICOLE ORTIZ
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1103TC0700XClinical Psychologist071010832IL
2390200000XStudent in an Organized Health Care Education/Training Program

General Provider Information

NPI Number : 1811443047
Entity Type Code : Individual
Provider Name (Legal Business Name) : NICOLE ORTIZ
Provider Business Mailing Address
First Line : 333 N MICHIGAN AVE STE 1400
Second Line :
City : CHICAGO
State : IL
Zip : 60601-4011
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 333 N MICHIGAN AVE STE 1400
Second Line :
City : CHICAGO
State : IL
Zip : 60601-4011
Country : US
Telephone Number : 312-815-9660
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/28/2016
Last Update Date : 10/04/2022

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Directions to “ NICOLE ORTIZ ” Practice Location

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