Provider Demographics
NPI:1831526888
Name:REISDORF, STEPHANIE
Entity type:Individual
Prefix:
First Name:STEPHANIE
Middle Name:
Last Name:REISDORF
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 1:5556 SHARPSBURG AVE
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89141-8687
Mailing Address - Country:US
Mailing Address - Phone:702-289-8435
Mailing Address - Fax:
Practice Address - Street 1:1515 E TROPICANA AVE STE 580
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89119-6517
Practice Address - Country:US
Practice Address - Phone:702-898-5311
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-10-06
Last Update Date:2020-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV8119-S1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical