Healthcare Provider Details

I. General information

NPI: 1265726988
Provider Name (Legal Business Name): REBECCA LYNN HEPNER-LISTON MSW, LSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/31/2011
Last Update Date: 05/31/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6070 S EASTERN AVE SUITE 200
LAS VEGAS NV
89119-3171
US

IV. Provider business mailing address

6070 S EASTERN AVE SUITE 200
LAS VEGAS NV
89119-3171
US

V. Phone/Fax

Practice location:
  • Phone: 269-492-2565
  • Fax:
Mailing address:
  • Phone: 269-492-2565
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number5956-S
License Number StateNV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: