MEDICARE: MS. NANCY B KUECKE LCSW

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	989361	CO

General Provider Information

NPI Number	:	1467647339
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. NANCY B KUECKE LCSW

Provider Business Mailing Address
First Line	:	2769 IRIS AVE
Second Line	:	STE 102
City	:	BOULDER
State	:	CO
Zip	:	80304-4405
Country	:	US
Telephone Number	:	303-442-1036
Fax Number	:	303-581-1030

Provider Business Practice Location Address
First Line	:	2769 IRIS AVE
Second Line	:	STE 102
City	:	BOULDER
State	:	CO
Zip	:	80304-4405
Country	:	US
Telephone Number	:	303-442-1036
Fax Number	:	303-581-1030

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

Provider Enumeration Date	:	09/13/2007
Last Update Date	:	09/13/2007

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