Individual
MRS. LATISHA SHANTA LEWIS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
M.A.T.
Contact information
Practice address
1948 RICHMOND SPRINGS LN, BELLEVILLE, IL 62220-3283
(618) 402-4319
(618) 825-0210
Mailing address
1948 RICHMOND SPRINGS LN, BELLEVILLE, IL 62220-3283
(618) 402-4319
Taxonomy
Speciality
Code
Description
License number
State
222Q00000X
Developmental Therapist
Primary
L200-5377-9925
IL
Other
Enumeration date
08/17/2011
Last updated
08/17/2011
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