Individual
JOLLENE D LATVALA
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LICSW
Contact information
Practice address
35382 US HIGHWAY 2, GRAND RAPIDS, MN 55744-4754
(218) 327-4886
(218) 327-4848
Mailing address
35382 US HIGHWAY 2, GRAND RAPIDS, MN 55744-4754
12183274886
(218) 327-4848
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
23638
MN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
23638
LICENSE NUMBER
MN
Enumeration date
05/24/2017
Last updated
05/24/2017
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