MEDICARE: KATHERINE DZIEZYC MILLICHAMP

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	1041C0700X	Clinical Social Worker	CSW.09929718	CO

General Provider Information

NPI Number	:	1649051095
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KATHERINE DZIEZYC MILLICHAMP

Provider Business Mailing Address
First Line	:	833 E ELLSWORTH AVE APT 208
Second Line	:
City	:	DENVER
State	:	CO
Zip	:	80209-2253
Country	:	US
Telephone Number	:	720-583-3930
Fax Number	:	720-970-8201

Provider Business Practice Location Address
First Line	:	833 E ELLSWORTH AVE APT 208
Second Line	:
City	:	DENVER
State	:	CO
Zip	:	80209-2253
Country	:	US
Telephone Number	:	720-583-3930
Fax Number	:	720-970-8201

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

Provider Enumeration Date	:	10/11/2023
Last Update Date	:	05/06/2026

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