MEDICARE: MARIA AGATA KRZECKA

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	101YM0800X	Mental Health Counselor

General Provider Information

NPI Number	:	1144511072
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MARIA AGATA KRZECKA

Provider Business Mailing Address
First Line	:	PO BOX 460
Second Line	:
City	:	BOUNTIFUL
State	:	UT
Zip	:	84011-0460
Country	:	US
Telephone Number	:	801-773-7060
Fax Number	:

Provider Business Practice Location Address
First Line	:	2909 WASHINGTON BLVD
Second Line	:
City	:	OGDEN
State	:	UT
Zip	:	84401-3744
Country	:	US
Telephone Number	:	888-801-1556
Fax Number	:

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

Provider Enumeration Date	:	04/26/2011
Last Update Date	:	02/15/2023

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Directions to “ MARIA AGATA KRZECKA ” Practice Location

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