Healthcare Provider Details

I. General information

NPI: 1821206327
Provider Name (Legal Business Name): LATANYA MARIE MCFIELD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/18/2007
Last Update Date: 06/10/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

400 E 41ST ST SUITE 101A
CHICAGO IL
60653-3071
US

IV. Provider business mailing address

17911 LOS ANGELES AVE
HOMEWOOD IL
60430-1509
US

V. Phone/Fax

Practice location:
  • Phone: 773-807-2144
  • Fax:
Mailing address:
  • Phone: 773-807-2144
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TM1800X
TaxonomyIntellectual & Developmental Disabilities Psychologist
License Number180006065
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: