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NPI Code Detail

MEDICARE: DRUSILLA REGAN WACKER MA, LPC

MEDICARE: DRUSILLA REGAN WACKER MA, 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
1101YP2500XProfessional Counselor6284CO
2101YM0800XMental Health Counselor178003750IL

General Provider Information

NPI Number : 1336392877
Entity Type Code : Individual
Provider Name (Legal Business Name) : DRUSILLA REGAN WACKER MA, LPC
Provider Business Mailing Address
First Line : 3205 N ACADEMY BLVD STE 130
Second Line :
City : COLORADO SPRINGS
State : CO
Zip : 80917-5152
Country : US
Telephone Number : 719-632-5700
Fax Number :
Provider Business Practice Location Address
First Line : 722 S WAHSATCH AVE
Second Line :
City : COLORADO SPRINGS
State : CO
Zip : 80903-4035
Country : US
Telephone Number : 719-632-5700
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 10/28/2008
Last Update Date : 12/05/2025

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