Provider Demographics
NPI:1689313694
Name:ORTIZ, WENDY R (MSW, LSW)
Entity Type:Individual
Prefix:
First Name:WENDY
Middle Name:R
Last Name:ORTIZ
Suffix:
Gender:F
Credentials:MSW, LSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6166 N SHERIDAN RD APT 4K
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60660-2832
Mailing Address - Country:US
Mailing Address - Phone:773-809-0403
Mailing Address - Fax:
Practice Address - Street 1:1740 RIDGE AVE STE 201
Practice Address - Street 2:
Practice Address - City:EVANSTON
Practice Address - State:IL
Practice Address - Zip Code:60201-5909
Practice Address - Country:US
Practice Address - Phone:847-475-7003
Practice Address - Fax:847-475-7333
Is Sole Proprietor?:Yes
Enumeration Date:2022-05-31
Last Update Date:2022-05-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL150106506104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes104100000XBehavioral Health & Social Service ProvidersSocial WorkerGroup - Single Specialty