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NPI Code Detail

MEDICARE: MRS. JODI NISWONGER L.C.S.W.

MEDICARE: MRS. JODI NISWONGER L.C.S.W.
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
11041C0700XClinical Social Worker5436-CNV

General Provider Information

NPI Number : 1376799718
Entity Type Code : Individual
Provider Name (Legal Business Name) : MRS. JODI NISWONGER L.C.S.W.
Provider Business Mailing Address
First Line : 6502 AFFERMATO ST
Second Line :
City : LAS VEGAS
State : NV
Zip : 89131-3147
Country : US
Telephone Number : 702-207-4469
Fax Number : 702-898-5310
Provider Business Practice Location Address
First Line : 7040 LAREDO ST
Second Line : SUITE D
City : LAS VEGAS
State : NV
Zip : 89117-3000
Country : US
Telephone Number : 702-898-5311
Fax Number : 702-898-5310
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/18/2008
Last Update Date : 08/18/2008

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