MEDICARE: KRYSTIN HEATHER ROSE MSW, LCSW

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
1	1041C0700X	Clinical Social Worker	9093-C	NV

General Provider Information

NPI Number	:	1558836551
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KRYSTIN HEATHER ROSE MSW, LCSW

Provider Business Mailing Address
First Line	:	8687 W SAHARA AVE STE 201
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89117-5869
Country	:	US
Telephone Number	:	702-830-9619
Fax Number	:	702-840-1033

Provider Business Practice Location Address
First Line	:	8687 W SAHARA AVE STE 201
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89117-5869
Country	:	US
Telephone Number	:	702-830-9619
Fax Number	:	702-840-1033

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/05/2018
Last Update Date	:	11/15/2023

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