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General NPI Number Information
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NPI Number | 1114417136
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Entity Type | Individual
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Provider Name | JENNIFER ORTIZ BCBA
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Gender | Female
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Dates
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Enumeration Date | 05/15/2018
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Last Update Date | 05/15/2018
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Provider Practice Location Address
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Address Line | 3040 N WILTON AVE FL 2
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City | CHICAGO
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State | IL
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Zip | 60657-4424
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Country | US
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Telephone | 678-988-0203
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Fax |
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Provider Business Mailing Address
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Address Line | 4730 N KIMBALL AVE APT 409
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City | CHICAGO
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State | IL
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Zip | 60625-8331
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103K00000X
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Taxonomy Name | Behavior Analyst
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License Number | 1-17-26073
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License Number State | IL
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