Provider Demographics
NPI:1578151882
Name:MALONEY-LATHAM, TAYLOR LAUREN
Entity type:Individual
Prefix:
First Name:TAYLOR
Middle Name:LAUREN
Last Name:MALONEY-LATHAM
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 1:518 S CENTER ST
Mailing Address - Street 2:
Mailing Address - City:PLANO
Mailing Address - State:IL
Mailing Address - Zip Code:60545-2006
Mailing Address - Country:US
Mailing Address - Phone:815-370-4045
Mailing Address - Fax:
Practice Address - Street 1:245 W ROOSEVELT RD
Practice Address - Street 2:
Practice Address - City:WEST CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60185-3739
Practice Address - Country:US
Practice Address - Phone:888-308-3728
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-01-04
Last Update Date:2024-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst