MEDICARE: ANDREA IKEDA LSW, MSW

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	7351-S	NV
2	1041C0700X	Clinical Social Worker	7351-S	NV

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	7351-S	OTHER	NV	LSW

General Provider Information

NPI Number	:	1548855364
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ANDREA IKEDA LSW, MSW

Provider Business Mailing Address
First Line	:	10155 W TWAIN AVE STE 110
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89147-6723
Country	:	US
Telephone Number	:	702-848-5644
Fax Number	:	702-848-5415

Provider Business Practice Location Address
First Line	:	10155 W TWAIN AVE STE 110
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89147-6723
Country	:	US
Telephone Number	:	702-791-1400
Fax Number	:	702-850-2820

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

Provider Enumeration Date	:	03/03/2021
Last Update Date	:	10/14/2021

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