Provider Demographics
NPI:1881131159
Name:GAMBLE, LADEANA (MSW)
Entity type:Individual
Prefix:MS
First Name:LADEANA
Middle Name:
Last Name:GAMBLE
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8685 S EASTERN AVE
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89123-2839
Mailing Address - Country:US
Mailing Address - Phone:702-754-0807
Mailing Address - Fax:702-754-0808
Practice Address - Street 1:8685 S EASTERN AVE
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89123-2839
Practice Address - Country:US
Practice Address - Phone:702-754-0807
Practice Address - Fax:702-754-0808
Is Sole Proprietor?:No
Enumeration Date:2017-01-25
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NVIC-11681041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV145600645Medicaid