Provider Demographics
NPI:1568034692
Name:LADIA, EDDA STANGE JR
Entity Type:Individual
Prefix:
First Name:EDDA
Middle Name:STANGE
Last Name:LADIA
Suffix:JR
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:824 BEECH AVE
Mailing Address - Street 2:
Mailing Address - City:JEAN
Mailing Address - State:NV
Mailing Address - Zip Code:89019-8503
Mailing Address - Country:US
Mailing Address - Phone:702-801-1577
Mailing Address - Fax:
Practice Address - Street 1:6767 W TROPICANA AVE
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89103-4754
Practice Address - Country:US
Practice Address - Phone:702-209-0370
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-07-16
Last Update Date:2023-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst