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1932413226
LATIA NICOLE SHANTAY RUSSELL
NORTH CHICAGO, IL
NPI
1932413226
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Entity Type
Individual
Gender
Female
Sole Proprietor ?
No
Primary Taxonomy
1041C0700X Social Worker, Clinical
(Licence: IL 149.014170)
Enumeration Date
2010-07-29
Last Update Date
2010-07-29
Business Address
Mrs. LATIA NICOLE SHANTAY RUSSELL LCSW
3001 GREEN BAY RD
NORTH CHICAGO, IL 60064-3048
Phone number: 847-688-1900
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Mailing Address
Mrs. LATIA NICOLE SHANTAY RUSSELL LCSW
3001 GREEN BAY RD
NORTH CHICAGO, IL 60064-3048
Phone number: 847-688-1900
Copy
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