Provider Demographics
NPI:1598887556
Name:FERN-RISKA, VICKI (LCSW)
Entity Type:Individual
Prefix:
First Name:VICKI
Middle Name:
Last Name:FERN-RISKA
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2310 BLACK RIVER FALLS DR
Mailing Address - Street 2:
Mailing Address - City:HENDERSON
Mailing Address - State:NV
Mailing Address - Zip Code:89044
Mailing Address - Country:US
Mailing Address - Phone:702-370-8894
Mailing Address - Fax:
Practice Address - Street 1:2310 BLACK RIVER FALLS DR
Practice Address - Street 2:
Practice Address - City:HENDERSON
Practice Address - State:NV
Practice Address - Zip Code:89044-0100
Practice Address - Country:US
Practice Address - Phone:702-370-8894
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-03
Last Update Date:2017-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV4501-C101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV1598887556Medicaid
NVEM622AMedicare UPIN