Provider Demographics
NPI:1285112359
Name:LATKO, MARISSA LYNN
Entity type:Individual
Prefix:
First Name:MARISSA
Middle Name:LYNN
Last Name:LATKO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11869 GOLDEN GATE DR
Mailing Address - Street 2:
Mailing Address - City:MOKENA
Mailing Address - State:IL
Mailing Address - Zip Code:60448-2027
Mailing Address - Country:US
Mailing Address - Phone:708-277-4121
Mailing Address - Fax:
Practice Address - Street 1:11869 GOLDEN GATE DR
Practice Address - Street 2:
Practice Address - City:MOKENA
Practice Address - State:IL
Practice Address - Zip Code:60448-2027
Practice Address - Country:US
Practice Address - Phone:708-277-4121
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-08-01
Last Update Date:2023-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical