Provider Demographics
NPI:1629746029
Name:ORTIZ, GLORIA
Entity Type:Individual
Prefix:
First Name:GLORIA
Middle Name:
Last Name:ORTIZ
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15127 S 73RD AVE STE G
Mailing Address - Street 2:
Mailing Address - City:ORLAND PARK
Mailing Address - State:IL
Mailing Address - Zip Code:60462-3425
Mailing Address - Country:US
Mailing Address - Phone:708-845-5500
Mailing Address - Fax:708-845-5505
Practice Address - Street 1:400 LATHROP AVE STE LL95
Practice Address - Street 2:
Practice Address - City:RIVER FOREST
Practice Address - State:IL
Practice Address - Zip Code:60305-1875
Practice Address - Country:US
Practice Address - Phone:708-845-5500
Practice Address - Fax:708-845-5505
Is Sole Proprietor?:No
Enumeration Date:2021-08-31
Last Update Date:2022-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health