Basic Information
| Provider Information | |||||||||
| NPI: | 1821426404 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | LATREILL | ||||||||
| FirstName: | JENNIFER | ||||||||
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| Credential: | M.S. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 325 SW FRAZIER AVE | ||||||||
| Address2: | |||||||||
| City: | TOPEKA | ||||||||
| State: | KS | ||||||||
| PostalCode: | 666061963 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7852956950 | ||||||||
| FaxNumber: | 8889725038 | ||||||||
| Practice Location | |||||||||
| Address1: | 325 SW FRAZIER AVE | ||||||||
| Address2: | |||||||||
| City: | TOPEKA | ||||||||
| State: | KS | ||||||||
| PostalCode: | 666061963 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7852956950 | ||||||||
| FaxNumber: | 8889725038 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/17/2013 | ||||||||
| LastUpdateDate: | 08/29/2019 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 222Q00000X | N | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Developmental Therapist | 103T00000X | 2946 | KS | Y | Behavioral Health & Social Service Providers | Psychologist |
No ID Information.