Individual
LATRISHA MOOBERRY
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LCSW
Contact information
Practice address
385 E IDLEWOOD ST, MORTON, IL 61550-2891
(309) 270-5425
Mailing address
385 E IDLEWOOD ST, MORTON, IL 61550-2891
(309) 263-5565
Taxonomy
Speciality
Code
Description
License number
State
104100000X
Social Worker
Primary
149022593
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
364276135
TAX ID
IL
Enumeration date
10/09/2020
Last updated
11/24/2021
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