Provider Demographics
NPI:1124268685
Name:SILCOTT, KAREN ZOEANNA (CSW INTERN)
Entity type:Individual
Prefix:
First Name:KAREN
Middle Name:ZOEANNA
Last Name:SILCOTT
Suffix:
Gender:F
Credentials:CSW INTERN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6164 PINE VILLA AVE
Mailing Address - Street 2:UNIT 204
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89108-5194
Mailing Address - Country:US
Mailing Address - Phone:702-327-4922
Mailing Address - Fax:
Practice Address - Street 1:6070 S EASTERN AVE
Practice Address - Street 2:SUITE 200
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89119-3171
Practice Address - Country:US
Practice Address - Phone:702-292-3774
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-02-24
Last Update Date:2009-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV5589-S104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker