Provider Demographics
NPI:1740559145
Name:DOCKSTADER-ORTIZ, PAMELA (PSYD)
Entity Type:Individual
Prefix:MRS
First Name:PAMELA
Middle Name:
Last Name:DOCKSTADER-ORTIZ
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:29 S WEBSTER ST STE 260
Mailing Address - Street 2:
Mailing Address - City:NAPERVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:60540-4560
Mailing Address - Country:US
Mailing Address - Phone:815-407-7236
Mailing Address - Fax:
Practice Address - Street 1:29 S WEBSTER ST
Practice Address - Street 2:STE 260
Practice Address - City:NAPERVILLE
Practice Address - State:IL
Practice Address - Zip Code:60540-4560
Practice Address - Country:US
Practice Address - Phone:262-201-4104
Practice Address - Fax:262-201-4095
Is Sole Proprietor?:Yes
Enumeration Date:2011-12-14
Last Update Date:2023-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL071008240103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical