MEDICARE: AGNIESZKA BAKLAZEC PLLC

Medicare Provider Information

Scope of Practice

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

#	Taxonomy Code	Taxonomy
1	101YP2500X	Professional Counselor
2	101YA0400X	Addiction (Substance Use Disorder) Counselor
3	101YM0800X	Mental Health Counselor

General Provider Information

NPI Number	:	1518729870
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	AGNIESZKA BAKLAZEC PLLC

Provider Business Mailing Address
First Line	:	1777 S BELLAIRE ST STE 419
Second Line	:
City	:	DENVER
State	:	CO
Zip	:	80222-4322
Country	:	US
Telephone Number	:	720-515-1368
Fax Number	:	303-759-0332

Provider Business Practice Location Address
First Line	:	1777 S BELLAIRE ST STE 419
Second Line	:
City	:	DENVER
State	:	CO
Zip	:	80222-4322
Country	:	US
Telephone Number	:	720-515-1368
Fax Number	:	303-759-0332

Authorized Official
Title or Position	:	OWNER
Name	:	AGNIESZKA BAKLAZEC
Credential	:	MA, LPC, LAC
Telephone Number	:	720-323-2628

Provider Enumeration Date	:	01/23/2024
Last Update Date	:	01/23/2024

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