Provider Demographics
NPI:1700595980
Name:COLEMAN, LATITIA S (LSW, MSW)
Entity Type:Individual
Prefix:MS
First Name:LATITIA
Middle Name:S
Last Name:COLEMAN
Suffix:
Gender:F
Credentials:LSW, MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8342 S WABASH AVE
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60619-4730
Mailing Address - Country:US
Mailing Address - Phone:773-632-6235
Mailing Address - Fax:
Practice Address - Street 1:30 PHELPS AVE
Practice Address - Street 2:
Practice Address - City:ROMEOVILLE
Practice Address - State:IL
Practice Address - Zip Code:60446-1335
Practice Address - Country:US
Practice Address - Phone:630-759-0201
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-11-16
Last Update Date:2022-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker