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Individual

MS. LA' WANDA TARA BASS

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
F

Contact information

Practice address
2020 W BONANZA RD, LAS VEGAS, NV 89106-4710
(702) 749-6332
Mailing address
5100 E TROPICANA AVE, APT # 8E, LAS VEGAS, NV 89122-6718
(702) 748-0757

Taxonomy

Speciality
Code
Description
License number
State
104100000X
Social Worker
225400000X
Rehabilitation Practitioner
Primary

Other

Enumeration date
06/05/2015
Last updated
06/08/2015
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