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General NPI Number Information
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NPI Number | 1275191306
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Entity Type | Individual
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Provider Name | JOHN LATHAM
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Gender | Male
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Dates
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Enumeration Date | 06/04/2019
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Last Update Date | 11/08/2023
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Provider Practice Location Address
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Address Line | 410 E JEFFERSON ST
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City | ANN ARBOR
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State | MI
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Zip | 48104-2311
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Country | US
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Telephone | 734-439-2922
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Fax |
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Provider Business Mailing Address
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Address Line | 410 E JEFFERSON ST
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City | ANN ARBOR
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State | MI
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Zip | 48104-2311
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Country | US
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Telephone | 734-439-2922
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | S.0027743
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License Number State | OH
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Taxonomy #2
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | 6802073603
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License Number State | MI
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