MEDICARE: STEPHANIE REISDORF

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	8119-S	NV

General Provider Information

NPI Number	:	1831526888
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	STEPHANIE REISDORF

Provider Business Mailing Address
First Line	:	5556 SHARPSBURG AVE
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89141-8687
Country	:	US
Telephone Number	:	702-289-8435
Fax Number	:

Provider Business Practice Location Address
First Line	:	1515 E TROPICANA AVE STE 580
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89119-6517
Country	:	US
Telephone Number	:	702-898-5311
Fax Number	:

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

Provider Enumeration Date	:	10/06/2013
Last Update Date	:	07/21/2020

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Directions to “ STEPHANIE REISDORF ” Practice Location

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