Healthcare Provider Details

I. General information

NPI: 1437793643
Provider Name (Legal Business Name): LEANNE LATOCHA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/30/2019
Last Update Date: 07/09/2026
Certification Date: 07/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4749 LINCOLN HWY SUITE 500
MATTESON IL
60443
US

IV. Provider business mailing address

4749 LINCOLN HWY SUITE 500
MATTESON IL
60443
US

V. Phone/Fax

Practice location:
  • Phone: 708-677-2600
  • Fax:
Mailing address:
  • Phone: 708-677-2600
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number152001433
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: