MEDICARE: MRS. MEREDITH RACHEL LEIGH KUCYK LSW, MSW, ADDC

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	101YA0400X	Addiction (Substance Use Disorder) Counselor	ADDC.0000274	CO
2	1041C0700X	Clinical Social Worker	LSW.0009924574	CO

General Provider Information

NPI Number	:	1336884147
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. MEREDITH RACHEL LEIGH KUCYK LSW, MSW, ADDC

Provider Business Mailing Address
First Line	:	2802 COUNTRY CLUB CIR
Second Line	:
City	:	COLORADO SPRINGS
State	:	CO
Zip	:	80909-1017
Country	:	US
Telephone Number	:	720-237-7240
Fax Number	:

Provider Business Practice Location Address
First Line	:	2802 COUNTRY CLUB CIR
Second Line	:
City	:	COLORADO SPRINGS
State	:	CO
Zip	:	80909-1017
Country	:	US
Telephone Number	:	720-237-7240
Fax Number	:

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

Provider Enumeration Date	:	05/05/2022
Last Update Date	:	08/09/2023

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