Individual
LATECIA SHACOLE LEAVY
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
15725 KEDZIE AVE, MARKHAM, IL 60428-3900
(312) 933-4320
(708) 232-2916
Mailing address
15725 KEDZIE AVE, MARKHAM, IL 60428-3900
(312) 933-4320
Taxonomy
Speciality
Code
Description
License number
State
222Q00000X
Developmental Therapist
Primary
—
IL
2355S0801X
Speech-Language Assistant
217000244
IL
Other
Enumeration date
07/01/2013
Last updated
08/14/2024
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