Provider Demographics
NPI:1548096274
Name:ORNELAS, MADISON GRACE (MHP)
Entity type:Individual
Prefix:
First Name:MADISON
Middle Name:GRACE
Last Name:ORNELAS
Suffix:
Gender:F
Credentials:MHP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:309 N INDIAN TRAIL
Mailing Address - Street 2:
Mailing Address - City:AURORA
Mailing Address - State:IL
Mailing Address - Zip Code:60506
Mailing Address - Country:US
Mailing Address - Phone:630-966-4110
Mailing Address - Fax:
Practice Address - Street 1:309 N INDIAN TRAIL
Practice Address - Street 2:
Practice Address - City:AURORA
Practice Address - State:IL
Practice Address - Zip Code:60506
Practice Address - Country:US
Practice Address - Phone:630-966-4110
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-09-10
Last Update Date:2024-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health