Healthcare Provider Details

I. General information

NPI: 1811462435
Provider Name (Legal Business Name): DENISE FAYE KRISCHKE LMSW, CSW-I
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: DENISE FAYE JORDAN

II. Dates (important events)

Enumeration Date: 10/10/2018
Last Update Date: 03/31/2022
Certification Date: 03/31/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2881 S VALLEY VIEW BLVD STE 6
LAS VEGAS NV
89102-0171
US

IV. Provider business mailing address

PO BOX 230355
LAS VEGAS NV
89105-0355
US

V. Phone/Fax

Practice location:
  • Phone: 702-922-7015
  • Fax: 702-922-6600
Mailing address:
  • Phone: 805-236-9925
  • Fax: 702-922-6600

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number9540-M
License Number StateNV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: