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General NPI Number Information
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NPI Number | 1548976350
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Entity Type | Individual
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Provider Name | REYNALDO ORTIZ-MALDONADO
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Gender | Male
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Dates
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Enumeration Date | 01/25/2023
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Last Update Date | 04/30/2025
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Provider Practice Location Address
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Address Line | 3900 W BROWN DEER RD STE 200
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City | BROWN DEER
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State | WI
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Zip | 53209-1220
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Country | US
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Telephone | 414-540-2170
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Fax | 414-540-2171
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Provider Business Mailing Address
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Address Line | 1726 N 1ST ST APT 216
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City | MILWAUKEE
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State | WI
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Zip | 53212-3911
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Country | US
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Telephone | 414-249-1273
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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 | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number |
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License Number State | WI
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Taxonomy #2
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | 12110-123
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License Number State | WI
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