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General NPI Number Information
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NPI Number | 1730851932
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Entity Type | Individual
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Provider Name | SHAVONDA LATRICE FIELDS
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Gender | Female
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Dates
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Enumeration Date | 10/05/2021
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Last Update Date | 10/05/2021
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Provider Practice Location Address
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Address Line | 1429 S KEDVALE AVE
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City | CHICAGO
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State | IL
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Zip | 60623-1246
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Country | US
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Telephone | 773-680-0710
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Fax |
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Provider Business Mailing Address
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Address Line | 3473 S KING DR # 215
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City | CHICAGO
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State | IL
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Zip | 60616-4108
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Country | US
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Telephone | 773-680-0710
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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 | 172A00000X
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Taxonomy Name | Driver
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License Number | F432-5915-7927
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License Number State | IL
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Taxonomy #2
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Taxonomy Code | 101YP1600X
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Taxonomy Name | Pastoral Counselor
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 251S00000X
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Taxonomy Name | Community/Behavioral Health Agency
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License Number |
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License Number State |
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Taxonomy #4
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Taxonomy Code | 347C00000X
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Taxonomy Name | Private Vehicle
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License Number |
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License Number State |
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Taxonomy #5
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Taxonomy Code | 372600000X
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Taxonomy Name | Adult Companion
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License Number |
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License Number State |
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