MEDICARE: CAITLYN MARIE KUDRECKI PLPC

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	101Y00000X	Counselor	PLC8728	LA

General Provider Information

NPI Number	:	1255108650
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CAITLYN MARIE KUDRECKI PLPC

Provider Business Mailing Address
First Line	:	2651 E NAPOLEON ST
Second Line	:
City	:	SULPHUR
State	:	LA
Zip	:	70663-3707
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	2651 E NAPOLEON ST
Second Line	:
City	:	SULPHUR
State	:	LA
Zip	:	70663-3707
Country	:	US
Telephone Number	:	337-625-6750
Fax Number	:

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

Provider Enumeration Date	:	12/06/2023
Last Update Date	:	12/06/2023

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