Individual
LATASHA JENEE STALLWORTH
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
4992 DONOVAN DR, GARFIELD HEIGHTS, OH 44125-2025
(216) 924-8012
Mailing address
11211 VERNON AVE, GARFIELD HEIGHTS, OH 44125-2727
(216) 308-7195
Taxonomy
Speciality
Code
Description
License number
State
376J00000X
Homemaker
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0122796
—
OH
05
—
1825645
—
OH
Enumeration date
03/08/2022
Last updated
03/08/2022
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