Organization
POWER
Active
Organization subpart
No
Provider details
NPI number
Authorized official
LATEENA SMITH EDS (OWNER/PSYCHOLOGIST PROVIDER)
(630) 398-6204
Entity
Organization
Contact information
Practice address
682 W BOUGHTON RD STE D, BOLINGBROOK, IL 60440-2199
(630) 398-6204
Mailing address
605 PICCADILLY LN, BOLINGBROOK, IL 60440-1021
Taxonomy
Speciality
Code
Description
License number
State
103TS0200X
School Psychologist
Primary
—
—
Other
Enumeration date
03/12/2018
Last updated
03/12/2018
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