MEDICARE: MICHELLE WESOLOWSKI LPC, NCC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YP2500X	Professional Counselor

General Provider Information

NPI Number	:	1063904084
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MICHELLE WESOLOWSKI LPC, NCC

Provider Business Mailing Address
First Line	:	1306 E UINTAH ST
Second Line	:
City	:	COLORADO SPRINGS
State	:	CO
Zip	:	80909-3744
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	5350 TOMAH DR STE 1100
Second Line	:
City	:	COLORADO SPRINGS
State	:	CO
Zip	:	80918-6902
Country	:	US
Telephone Number	:	719-466-6854
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/05/2018
Last Update Date	:	12/29/2019

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