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General NPI Number Information
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NPI Number | 1700552114
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Entity Type | Individual
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Provider Name | KERRILYNN J LATTA LCSW
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Gender | Female
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Dates
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Enumeration Date | 08/17/2021
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Last Update Date | 11/16/2022
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Provider Practice Location Address
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Address Line | 11225 N 28TH DR STE A-10214
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City | PHOENIX
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State | AZ
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Zip | 85029-5606
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Country | US
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Telephone | 623-203-5151
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Fax | 480-718-7487
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Provider Business Mailing Address
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Address Line | 11225 N 28TH DR STE A-10214
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City | PHOENIX
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State | AZ
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Zip | 85029-5606
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Country | US
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Telephone | 623-203-5151
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Fax | 480-718-7487
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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 | LCSW-19734
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License Number State | AZ
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