Individual
LATESHA EDMON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
6519 W BRANHAM LN, LAVEEN, AZ 85339-2723
(815) 514-8647
Mailing address
22388 W LA VISTA CIR, BUCKEYE, AZ 85326-3971
(815) 514-8647
Taxonomy
Speciality
Code
Description
License number
State
322D00000X
Emotionally Disturbed Childrens' Residential Treatment Facility
Primary
—
—
Other
Enumeration date
02/10/2025
Last updated
02/10/2025
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