Healthcare Provider Details

I. General information

NPI: 1508779497
Provider Name (Legal Business Name): KATHLEEN ELIZABETH LATZ LSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/23/2026
Last Update Date: 09/23/2026
Certification Date: 09/23/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

915 W HAWTHORN DR
ITASCA IL
60143-2056
US

IV. Provider business mailing address

5151 MOCHEL DR STE 304
DOWNERS GROVE IL
60515-5078
US

V. Phone/Fax

Practice location:
  • Phone: 630-445-1666
  • Fax: 630-775-8490
Mailing address:
  • Phone: 630-324-4663
  • Fax: 630-395-9974

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number150.117943
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: