MEDICARE: KAREN ZOEANNA SILCOTT CSW INTERN

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	104100000X	Social Worker	5589-S	NV

General Provider Information

NPI Number	:	1124268685
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KAREN ZOEANNA SILCOTT CSW INTERN

Provider Business Mailing Address
First Line	:	6164 PINE VILLA AVE
Second Line	:	UNIT 204
City	:	LAS VEGAS
State	:	NV
Zip	:	89108-5194
Country	:	US
Telephone Number	:	702-327-4922
Fax Number	:

Provider Business Practice Location Address
First Line	:	6070 S EASTERN AVE
Second Line	:	SUITE 200
City	:	LAS VEGAS
State	:	NV
Zip	:	89119-3171
Country	:	US
Telephone Number	:	702-292-3774
Fax Number	:

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

Provider Enumeration Date	:	02/24/2009
Last Update Date	:	09/30/2009

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