Individual
JOHANNA MCKIDDY
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
3513 E RUSSELL RD STE D, LAS VEGAS, NV 89120-2244
(702) 826-3334
Mailing address
3513 E RUSSELL RD STE D, LAS VEGAS, NV 89120-2244
(702) 826-3334
Taxonomy
Speciality
Code
Description
License number
State
104100000X
Social Worker
Primary
7097-S
NV
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
813759684
—
NV
Enumeration date
12/15/2016
Last updated
12/15/2016
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