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Individual

ANDREA IKEDA

Active
Sole proprietor
No

Provider details

NPI number
Gender
F
Credential
LSW, MSW

Contact information

Practice address
10155 W TWAIN AVE STE 110, LAS VEGAS, NV 89147-6723
(702) 791-1400
(702) 850-2820
Mailing address
10155 W TWAIN AVE STE 110, LAS VEGAS, NV 89147-6723
(702) 848-5644
(702) 848-5415

Taxonomy

Speciality
Code
Description
License number
State
104100000X
Social Worker
7351-S
NV
1041C0700X
Clinical Social Worker
Primary
7351-S
NV

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
7351-S
LSW
NV
Enumeration date
03/03/2021
Last updated
10/14/2021
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