LATIA NICOLE SHANTAY RUSSELL Social Worker License verification

Business Entity

ACTIVE

License Type

Social Worker

Description

LICENSED CLINICAL SOCIAL WORKER

License Number

149014170

License Status

ACTIVE

Business

First Name

LATIA

Middle

NICOLE SHANTAY

Last Name

RUSSELL

Business Name

LATIA NICOLE SHANTAY RUSSELL

Original Issue Date

05/19/2010

Effective Date

10/27/2025

Expiration Date

11/30/2027

City

PLEASANT PRAIRIE

State

Zip

53158

County

WISCONSIN

Ever Disciplined

LastModifiedDate

10/27/2025