Healthcare Provider Details

I. General information

NPI: 1134043888
Provider Name (Legal Business Name): ROYNA LATTIMORE
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/06/2026
Last Update Date: 08/06/2026
Certification Date: 08/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

522 GLENWOOD AVE
NEW BOSTON OH
45662-5505
US

IV. Provider business mailing address

522 GLENWOOD AVE
NEW BOSTON OH
45662-5505
US

V. Phone/Fax

Practice location:
  • Phone: 740-354-0269
  • Fax: 740-354-0280
Mailing address:
  • Phone: 740-354-0269
  • Fax: 740-354-0280

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TS0200X
TaxonomySchool Psychologist
License Number01616
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: