Healthcare Provider Details

I. General information

NPI: 1104518398
Provider Name (Legal Business Name): LEILA ORTIZ PHD INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/24/2023
Last Update Date: 05/24/2023
Certification Date: 05/24/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

750 NORTHWEST HWY APT 240
DES PLAINES IL
60016-3073
US

IV. Provider business mailing address

750 NORTHWEST HWY APT 240
DES PLAINES IL
60016-3073
US

V. Phone/Fax

Practice location:
  • Phone: 312-841-3215
  • Fax:
Mailing address:
  • Phone: 312-841-3215
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number
License Number State

VIII. Authorized Official

Name: DR. LEILA ORTIZ
Title or Position: OWNER/PSYCHOLOGIST
Credential: PHD
Phone: 312-841-3215