Healthcare Provider Details

I. General information

NPI: 1326961368
Provider Name (Legal Business Name): JESSICA A ORTIZ LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/04/2026
Last Update Date: 08/04/2026
Certification Date: 08/03/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1234 MAIN ST
GREEN BAY WI
54302-1307
US

IV. Provider business mailing address

1603 WESTFIELD AVE
GREEN BAY WI
54303-3340
US

V. Phone/Fax

Practice location:
  • Phone: 920-660-0596
  • Fax:
Mailing address:
  • Phone: 920-660-0596
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number12750125
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: