MEDICARE: LISA M UZZILIA STAUDER LPC

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	4151	CO

General Provider Information

NPI Number	:	1932120425
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LISA M UZZILIA STAUDER LPC

Provider Business Mailing Address
First Line	:	2045 SHAWNEE DR
Second Line	:
City	:	COLORADO SPRINGS
State	:	CO
Zip	:	80915-1921
Country	:	US
Telephone Number	:	719-342-0898
Fax Number	:

Provider Business Practice Location Address
First Line	:	815 N NEVADA AVE
Second Line	:	210
City	:	COLORADO SPRINGS
State	:	CO
Zip	:	80903-4726
Country	:	US
Telephone Number	:	719-342-0898
Fax Number	:

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

Provider Enumeration Date	:	07/21/2006
Last Update Date	:	07/08/2007

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