MEDICARE: MINDY KATHRYN KOLODZIEJSKI GC

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	170300000X	Genetic Counselor (M.S.)	GC581	KY

General Provider Information

NPI Number	:	1396598405
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MINDY KATHRYN KOLODZIEJSKI GC

Provider Business Mailing Address
First Line	:	138 LEADER AVE, STE 116
Second Line	:
City	:	LEXINGTON
State	:	KY
Zip	:	40508-3215
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	740 S LIMESTONE STE K201
Second Line	:
City	:	LEXINGTON
State	:	KY
Zip	:	40536-3215
Country	:	US
Telephone Number	:	859-218-2509
Fax Number	:	859-323-3499

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

Provider Enumeration Date	:	04/09/2024
Last Update Date	:	05/15/2025

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