Provider Demographics
NPI:1386124295
Name:SEDZRO, MAWUENA IGOL KWAME
Entity type:Individual
Prefix:
First Name:MAWUENA
Middle Name:IGOL KWAME
Last Name:SEDZRO
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3925 N MARTIN L KING BLVD STE 202
Mailing Address - Street 2:
Mailing Address - City:NORTH LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89032-7675
Mailing Address - Country:US
Mailing Address - Phone:702-909-9333
Mailing Address - Fax:702-909-9262
Practice Address - Street 1:3925 N MARTIN L KING BLVD STE 202
Practice Address - Street 2:
Practice Address - City:NORTH LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89032-7675
Practice Address - Country:US
Practice Address - Phone:702-909-9333
Practice Address - Fax:702-909-9262
Is Sole Proprietor?:Yes
Enumeration Date:2018-08-20
Last Update Date:2018-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst