Provider Demographics
NPI:1205062627
Name:SZOSTAK, ANNA URSZULA (CADC)
Entity type:Individual
Prefix:
First Name:ANNA
Middle Name:URSZULA
Last Name:SZOSTAK
Suffix:
Gender:F
Credentials:CADC
Other - Prefix:
Other - First Name:ANNA
Other - Middle Name:URSZULA
Other - Last Name:VILAY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LADC
Mailing Address - Street 1:7341 MARBURY ST
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89166-5261
Mailing Address - Country:US
Mailing Address - Phone:702-970-0343
Mailing Address - Fax:
Practice Address - Street 1:6048 S DURANGO DR STE 115
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89113-1781
Practice Address - Country:US
Practice Address - Phone:702-815-1550
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-06-01
Last Update Date:2023-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV00383-C101YA0400X
MN302804101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)