Healthcare Provider Details

I. General information

NPI: 1629360136
Provider Name (Legal Business Name): MONICA ALICIA ORTIZ LMSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/03/2011
Last Update Date: 06/08/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

812 E. JOLLY ROAD SUITE 216
LANSING MI
48910
US

IV. Provider business mailing address

812 E. JOLLY ROAD SUITE 210
LANSING MI
48910-6821
US

V. Phone/Fax

Practice location:
  • Phone: 517-346-9608
  • Fax: 517-346-8291
Mailing address:
  • Phone: 517-346-8223
  • Fax: 517-346-8291

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number6801088300
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: