Healthcare Provider Details

I. General information

NPI: 1407760705
Provider Name (Legal Business Name): LATOYA R WYCHE
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/01/2026
Last Update Date: 10/01/2026
Certification Date: 10/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

126 ISLAND POND RD
SPRINGFIELD MA
01118-1029
US

IV. Provider business mailing address

52 ALSACE ST
SPRINGFIELD MA
01108-3057
US

V. Phone/Fax

Practice location:
  • Phone: 773-905-1014
  • Fax:
Mailing address:
  • Phone: 413-777-6523
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: