Provider Demographics
NPI:1447149422
Name:TAGGER, LA TORIA SHANAY (CHW, DOULA)
Entity type:Individual
Prefix:
First Name:LA TORIA
Middle Name:SHANAY
Last Name:TAGGER
Suffix:
Gender:F
Credentials:CHW, DOULA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15468 HEYDEN ST
Mailing Address - Street 2:
Mailing Address - City:DETROIT
Mailing Address - State:MI
Mailing Address - Zip Code:48223-1747
Mailing Address - Country:US
Mailing Address - Phone:734-299-0801
Mailing Address - Fax:
Practice Address - Street 1:15468 HEYDEN ST
Practice Address - Street 2:
Practice Address - City:DETROIT
Practice Address - State:MI
Practice Address - Zip Code:48223-1747
Practice Address - Country:US
Practice Address - Phone:734-299-0801
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-07-02
Last Update Date:2025-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI374J00000X, 172V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374J00000XNursing Service Related ProvidersDoula
No172V00000XOther Service ProvidersCommunity Health Worker