Provider Demographics
NPI:1891551859
Name:ORTIZ, EMMA CRISTINA
Entity Type:Individual
Prefix:MRS
First Name:EMMA
Middle Name:CRISTINA
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 1:113 MAIN ST STE 203
Mailing Address - Street 2:
Mailing Address - City:OSWEGO
Mailing Address - State:IL
Mailing Address - Zip Code:60543-2305
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:31 W DOWNER PL
Practice Address - Street 2:SUITE 100
Practice Address - City:AURORA
Practice Address - State:IL
Practice Address - Zip Code:60506-5126
Practice Address - Country:US
Practice Address - Phone:630-733-9108
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-02-26
Last Update Date:2024-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL180.015760101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional