Provider Demographics
NPI:1174097927
Name:ORTIZ, JOCELYN (MA)
Entity type:Individual
Prefix:
First Name:JOCELYN
Middle Name:
Last Name:ORTIZ
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5343 W SCHUBERT AVE
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60639-1522
Mailing Address - Country:US
Mailing Address - Phone:773-744-1996
Mailing Address - Fax:
Practice Address - Street 1:707 WISNER ST
Practice Address - Street 2:
Practice Address - City:PARK RIDGE
Practice Address - State:IL
Practice Address - Zip Code:60068-2708
Practice Address - Country:US
Practice Address - Phone:847-653-4329
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-01-15
Last Update Date:2019-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL2319180103TS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TS0200XBehavioral Health & Social Service ProvidersPsychologistSchool