MEDICARE: PATRICIA JOAN SZAMBELAN MS,LPC,CSAC

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	7797-125	WI
2	101YA0400X	Addiction (Substance Use Disorder) Counselor	16446-132	WI
3	101YM0800X	Mental Health Counselor	7797-125	WI
4	261QM0801X	Mental Health Clinic/Center (Including Community Mental Health Center)	7797-125	WI
5	101YP2500X	Professional Counselor	7797	WI

General Provider Information

NPI Number	:	1275028508
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	PATRICIA JOAN SZAMBELAN MS,LPC,CSAC

Provider Business Mailing Address
First Line	:	4140 GANDY DANCER RD
Second Line	:
City	:	DEFOREST
State	:	WI
Zip	:	53532-9118
Country	:	US
Telephone Number	:	608-931-2805
Fax Number	:

Provider Business Practice Location Address
First Line	:	787 LOIS DR
Second Line	:
City	:	SUN PRAIRIE
State	:	WI
Zip	:	53590-1177
Country	:	US
Telephone Number	:	608-931-2805
Fax Number	:

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

Provider Enumeration Date	:	06/28/2018
Last Update Date	:	05/23/2025

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