Provider Demographics
NPI:1497229116
Name:LASSAHN, STEPHANIA
Entity Type:Individual
Prefix:
First Name:STEPHANIA
Middle Name:
Last Name:LASSAHN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:STEPHANIA
Other - Middle Name:
Other - Last Name:HOMIC
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:6490 S MCCARRAN BLVD UNIT 21
Mailing Address - Street 2:
Mailing Address - City:RENO
Mailing Address - State:NV
Mailing Address - Zip Code:89509-6165
Mailing Address - Country:US
Mailing Address - Phone:775-825-7500
Mailing Address - Fax:775-825-7550
Practice Address - Street 1:6490 S MCCARRAN BLVD UNIT 21
Practice Address - Street 2:
Practice Address - City:RENO
Practice Address - State:NV
Practice Address - Zip Code:89509-6165
Practice Address - Country:US
Practice Address - Phone:775-825-7500
Practice Address - Fax:775-825-7550
Is Sole Proprietor?:Yes
Enumeration Date:2019-01-15
Last Update Date:2019-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician