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General NPI Number Information
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NPI Number | 1891580213
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Entity Type | Individual
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Provider Name | LATANDA TERRY-GRAVES
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Gender | Female
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Dates
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Enumeration Date | 04/14/2025
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Last Update Date | 04/14/2025
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Provider Practice Location Address
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Address Line | 10046 S WESTERN AVE
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City | CHICAGO
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State | IL
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Zip | 60643-1926
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Country | US
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Telephone | 773-429-0300
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Fax | 773-429-5736
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Provider Business Mailing Address
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Address Line | 8447 S GREEN ST
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City | CHICAGO
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State | IL
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Zip | 60620-3208
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Country | US
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Telephone | 773-557-2743
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Fax | 773-429-0300
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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 | 101YS0200X
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Taxonomy Name | School Counselor
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License Number | 16329385
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License Number State | IL
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