MEDICARE: MISS KACEE MARIE MYCZKOWIAK SWLC

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	6801102705	MI
2	1041C0700X	Clinical Social Worker

General Provider Information

NPI Number	:	1366924250
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MISS KACEE MARIE MYCZKOWIAK SWLC

Provider Business Mailing Address
First Line	:	1820 6TH ST W
Second Line	:
City	:	BILLINGS
State	:	MT
Zip	:	59102-3604
Country	:	US
Telephone Number	:	989-245-0966
Fax Number	:

Provider Business Practice Location Address
First Line	:	1750 RAY OF HOPE LN
Second Line	:
City	:	BILLINGS
State	:	MT
Zip	:	59106-3502
Country	:	US
Telephone Number	:	406-656-2198
Fax Number	:

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

Provider Enumeration Date	:	09/06/2018
Last Update Date	:	06/24/2025

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Directions to “ MISS KACEE MARIE MYCZKOWIAK SWLC” Practice Location

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