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NPI Code Detail

MEDICARE: COURTNEY KAUCHAK MSW, LCSW

MEDICARE: COURTNEY KAUCHAK MSW, 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
1101Y00000XCounselor

General Provider Information

NPI Number : 1740724434
Entity Type Code : Individual
Provider Name (Legal Business Name) : COURTNEY KAUCHAK MSW, LCSW
Provider Business Mailing Address
First Line : 68467 PEREGRINE PERCH
Second Line :
City : GOSHEN
State : IN
Zip : 46526-8586
Country : US
Telephone Number : 574-529-4620
Fax Number :
Provider Business Practice Location Address
First Line : 3220 E JEFFERSON BLVD
Second Line :
City : SOUTH BEND
State : IN
Zip : 46615-3028
Country : US
Telephone Number : 574-222-2466
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 12/14/2016
Last Update Date : 09/26/2023

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