Healthcare Provider Details

I. General information

NPI: 1891551859
Provider Name (Legal Business Name): MRS. EMMA CRISTINA ORTIZ
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/26/2024
Last Update Date: 02/26/2024
Certification Date: 02/26/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

31 W DOWNER PL SUITE 100
AURORA IL
60506-5126
US

IV. Provider business mailing address

113 MAIN ST STE 203
OSWEGO IL
60543-2305
US

V. Phone/Fax

Practice location:
  • Phone: 630-733-9108
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number180.015760
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: