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General NPI Number Information
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NPI Number | 1659685147
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Entity Type | Individual
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Provider Name | LEAH MARIE WASICKA LPC
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Gender | Female
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Dates
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Enumeration Date | 07/27/2010
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Last Update Date | 07/27/2010
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Provider Practice Location Address
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Address Line | 7400 E ARAPAHOE RD
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City | CENTENNIAL
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State | CO
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Zip | 80112-1279
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Country | US
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Telephone | 303-741-1077
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Fax | 303-741-1078
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Provider Business Mailing Address
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Address Line | 677 E EISENHOWER BLVD
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City | LOVELAND
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State | CO
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Zip | 80537-3919
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Country | US
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Telephone | 303-620-6909
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number | 5635
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License Number State | CO
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