Provider Demographics
NPI:1417007493
Name:ORTIZ, CECILIA TERESA (MSW LCSW)
Entity Type:Individual
Prefix:MRS
First Name:CECILIA
Middle Name:TERESA
Last Name:ORTIZ
Suffix:
Gender:F
Credentials:MSW LCSW
Other - Prefix:MRS
Other - First Name:TERESA
Other - Middle Name:C
Other - Last Name:ORTIZ
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MSW, LCSW
Mailing Address - Street 1:10150 W NATIONAL AVE
Mailing Address - Street 2:STE 370
Mailing Address - City:WEST ALLIS
Mailing Address - State:WI
Mailing Address - Zip Code:53227-2152
Mailing Address - Country:US
Mailing Address - Phone:262-782-2090
Mailing Address - Fax:262-782-2092
Practice Address - Street 1:10150 W NATIONAL AVE
Practice Address - Street 2:STE 370
Practice Address - City:WEST ALLIS
Practice Address - State:WI
Practice Address - Zip Code:53227-2152
Practice Address - Country:US
Practice Address - Phone:262-782-2090
Practice Address - Fax:262-782-2092
Is Sole Proprietor?:No
Enumeration Date:2007-01-11
Last Update Date:2018-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI6871231041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI40941100Medicaid
WI40941100Medicaid