Healthcare Provider Details

I. General information

NPI: 1982917456
Provider Name (Legal Business Name): HEATHER JEAN LATTA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/26/2010
Last Update Date: 03/02/2026
Certification Date: 03/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

408 S 4TH ST
EFFINGHAM IL
62401-3703
US

IV. Provider business mailing address

408 S 4TH ST
EFFINGHAM IL
62401-3703
US

V. Phone/Fax

Practice location:
  • Phone: 217-347-5118
  • Fax: 217-347-7069
Mailing address:
  • Phone: 217-347-5118
  • Fax: 217-347-7609

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number149.011337
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: