Provider Demographics
NPI:1437793643
Name:LATOCHA, LEANNE
Entity type:Individual
Prefix:
First Name:LEANNE
Middle Name:
Last Name:LATOCHA
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6249 CARRIAGE WAY
Mailing Address - Street 2:
Mailing Address - City:OAK FOREST
Mailing Address - State:IL
Mailing Address - Zip Code:60452-6026
Mailing Address - Country:US
Mailing Address - Phone:708-677-2600
Mailing Address - Fax:
Practice Address - Street 1:6249 CARRIAGE WAY
Practice Address - Street 2:
Practice Address - City:OAK FOREST
Practice Address - State:IL
Practice Address - Zip Code:60452-6026
Practice Address - Country:US
Practice Address - Phone:708-677-2600
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-10-30
Last Update Date:2025-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI106S00000X
103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
No106S00000XBehavioral Health & Social Service ProvidersBehavior Technician