Provider Demographics
NPI:1821837436
Name:LASKOWSKI, NICOLE CELIN
Entity type:Individual
Prefix:
First Name:NICOLE
Middle Name:CELIN
Last Name:LASKOWSKI
Suffix:
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 1:5526 FOWLER PLAINS CT
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89131-5923
Mailing Address - Country:US
Mailing Address - Phone:702-979-8899
Mailing Address - Fax:
Practice Address - Street 1:3101 W CHARLESTON BLVD
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89102-1931
Practice Address - Country:US
Practice Address - Phone:702-831-6670
Practice Address - Fax:702-831-6671
Is Sole Proprietor?:Yes
Enumeration Date:2024-05-22
Last Update Date:2024-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NVRBT4266106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior TechnicianGroup - Single Specialty