Individual
LATISHA SMITH
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
ED.S.
Contact information
Practice address
600 S. SMILEY ST., O'FALLON, IL 62269
(618) 632-3507
Mailing address
600 S. SMILEY ST., O'FALLON, IL 62269
Taxonomy
Speciality
Code
Description
License number
State
103TS0200X
School Psychologist
Primary
—
—
Other
Enumeration date
11/30/2017
Last updated
11/30/2017
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