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NPI Code Detail

MEDICARE: DR. STACEY PICCONE

MEDICARE: DR. STACEY PICCONE
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
1231H00000XAudiologistLD60230650WA
2231H00000XAudiologistAUD.0000764CO

General Provider Information

NPI Number : 1376831958
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. STACEY PICCONE
Provider Business Mailing Address
First Line : 1625 MEDICAL CENTER PT
Second Line : STE 210
City : COLORADO SPRINGS
State : CO
Zip : 80907-5798
Country : US
Telephone Number : 719-635-5148
Fax Number : 719-448-0164
Provider Business Practice Location Address
First Line : 2 S CASCADE AVE
Second Line : STE 140
City : COLORADO SPRINGS
State : CO
Zip : 80903-1624
Country : US
Telephone Number : 719-538-2900
Fax Number : 719-538-2987
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/15/2011
Last Update Date : 08/09/2016

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Directions to “ DR. STACEY PICCONE ” Practice Location

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