Healthcare Provider Details

I. General information

NPI: 1154725471
Provider Name (Legal Business Name): LA'TASHA THOMAS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/15/2014
Last Update Date: 04/11/2025
Certification Date: 04/11/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

20600 CHAGRIN BLVD STE 320
SHAKER HEIGHTS OH
44122-5334
US

IV. Provider business mailing address

10100 ELIDA RD
DELPHOS OH
45833-9058
US

V. Phone/Fax

Practice location:
  • Phone: 216-295-7239
  • Fax: 216-295-7240
Mailing address:
  • Phone: 419-695-8010
  • Fax: 419-932-6232

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License NumberS.1302632
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: