MEDICARE: KEVIN WYSOCKI

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	101Y00000X	Counselor	7060-226	WI

General Provider Information

NPI Number	:	1154045474
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KEVIN WYSOCKI

Provider Business Mailing Address
First Line	:	17345 CIVIC DR STE 1331
Second Line	:
City	:	BROOKFIELD
State	:	WI
Zip	:	53045-5070
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	17345 CIVIC DR STE 1331
Second Line	:
City	:	BROOKFIELD
State	:	WI
Zip	:	53045-5070
Country	:	US
Telephone Number	:	262-462-0216
Fax Number	:

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

Provider Enumeration Date	:	09/29/2022
Last Update Date	:	09/29/2022

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Directions to “ KEVIN WYSOCKI ” Practice Location

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