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NPI Code Detail

MEDICARE: LATRICE S NEWSON

MEDICARE: LATRICE S NEWSON
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1103K00000XBehavior Analyst

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1XOH836546548OTHERILBLUE CROSS BLUE SHIELD

General Provider Information

NPI Number : 1588107809
Entity Type Code : Individual
Provider Name (Legal Business Name) : LATRICE S NEWSON
Provider Business Mailing Address
First Line : 10021 S WOOD ST
Second Line :
City : CHICAGO
State : IL
Zip : 60643-2009
Country : US
Telephone Number : 312-882-7224
Fax Number :
Provider Business Practice Location Address
First Line : 3315 SPRING MOUNTAIN RD
Second Line :
City : LAS VEGAS
State : NV
Zip : 89102-8603
Country : US
Telephone Number : 702-754-3484
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 11/19/2016
Last Update Date : 11/19/2016

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Directions to “ LATRICE S NEWSON ” Practice Location

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