Individual
AMY J SONG
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
MSW, LICSW
Contact information
Practice address
4700 LAS VEGAS BLVD N, NELLIS AFB, NV 89191-6600
(702) 653-2965
Mailing address
4700 LAS VEGAS BLVD N, NELLIS AFB, NV 89191-6601
(702) 653-2965
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
LW60422621
WA
225700000X
Massage Therapist
MA60319179
WA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
2044158
—
WA
Enumeration date
07/07/2011
Last updated
07/21/2022
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