Provider Demographics
NPI:1548816580
Name:WILLIAMS, LATARA
Entity type:Individual
Prefix:MRS
First Name:LATARA
Middle Name:
Last Name:WILLIAMS
Suffix:
Gender:F
Credentials:
Other - Prefix:MS
Other - First Name:LATARA
Other - Middle Name:V
Other - Last Name:WRIGHT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2447 N 50TH ST
Mailing Address - Street 2:
Mailing Address - City:MILWAUKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53210-2815
Mailing Address - Country:US
Mailing Address - Phone:702-504-6400
Mailing Address - Fax:
Practice Address - Street 1:2447 N 50TH ST
Practice Address - Street 2:
Practice Address - City:MILWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53210-2815
Practice Address - Country:US
Practice Address - Phone:702-504-6400
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-08-15
Last Update Date:2019-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health