Provider Information for 1164837282
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DORIAN ORTEGA LCPC
Sex: Female
NPI: 1164837282
Last Updated: 2021-04-15
Certification Date: 2021-04-15
Certification Date: 2021-04-15
Details
| Name | Value | ||||||||||||||
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| NPI | 1164837282 | ||||||||||||||
| Enumeration Date | 2014-06-26 | ||||||||||||||
| NPI Type | NPI-1 Individual | ||||||||||||||
| Sole Proprietor | YES | ||||||||||||||
| Status | Active | ||||||||||||||
| Mailing Address | 1711 W JARVIS AVE APT 306 CHICAGO, IL 60626-7616 United States Phone: 773-469-0709 | Fax: | ||||||||||||||
| Primary Practice Address | 2657 W DIVISION ST CHICAGO, IL 60622-2851 United States Phone: 773-469-0709 | Fax: | ||||||||||||||
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