Latisha Annette Black, CDPT, BAS

Primary specialty

Student in an Organized Health Care Education/Training ProgramTaxonomy code 390200000X

License

C060492588 Issued in WA

Practice address

1111 Fawcett Ave Ste 200
Tacoma, WA 98402-2029

Phone

(253) 274-0484

NPI assigned

May 21, 2019

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Pioneer Human Services

  • Community/Behavioral Health Agency
  • Tacoma, WA
  • NPI 1003939034
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1558396800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1558396800000",
    "number": "1427615905",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1111 FAWCETT AVE STE 200",
            "city": "TACOMA",
            "state": "WA",
            "postal_code": "984022029",
            "telephone_number": "253-274-0484"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1111 FAWCETT AVE STE 200",
            "city": "TACOMA",
            "state": "WA",
            "postal_code": "984022029",
            "telephone_number": "253-274-0484"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BLACK",
        "first_name": "LATISHA",
        "middle_name": "ANNETTE",
        "credential": "CDPT, BAS",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2019-05-21",
        "last_updated": "2019-05-21",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": "WA",
            "license": "C060492588",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Marcela Bivol
• Kimberley Bjorn, LICSW
• Black Birth
• Black Diamond Advocacy
• Kaylee Erin Black
• Leah I. Black, RN
• Matthew Black
• Rebecca Black
• Jaymee Blackbourn
• Caleb Anthony Blackhurst, DDS

• Student in an Organized Health Care Education/Training Program in Tacoma, WA
• Providers in Tacoma, WA by specialty
• Student in an Organized Health Care Education/Training Program in Washington

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 21, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.