Healthcare Provider Details

I. General information

NPI: 1548976350
Provider Name (Legal Business Name): REYNALDO ORTIZ-MALDONADO
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/25/2023
Last Update Date: 04/30/2025
Certification Date: 04/30/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3900 W BROWN DEER RD STE 200
BROWN DEER WI
53209-1220
US

IV. Provider business mailing address

1726 N 1ST ST APT 216
MILWAUKEE WI
53212-3911
US

V. Phone/Fax

Practice location:
  • Phone: 414-540-2170
  • Fax: 414-540-2171
Mailing address:
  • Phone: 414-249-1273
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number
License Number StateWI
# 2
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number12110-123
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: