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NPI Code Detail

MEDICARE: MARISSA NOWICKI

MEDICARE: MARISSA NOWICKI
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
1103K00000XBehavior Analyst1-24-71342CO

General Provider Information

NPI Number : 1831734912
Entity Type Code : Individual
Provider Name (Legal Business Name) : MARISSA NOWICKI
Provider Business Mailing Address
First Line : 4135 SHELBE CT
Second Line :
City : COLORADO SPRINGS
State : CO
Zip : 80911-5208
Country : US
Telephone Number : 715-492-2858
Fax Number :
Provider Business Practice Location Address
First Line : 3535 PARKMOOR VILLAGE DR
Second Line :
City : COLORADO SPRINGS
State : CO
Zip : 80917-5292
Country : US
Telephone Number : 719-232-3498
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 11/12/2019
Last Update Date : 02/21/2024

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Directions to “ MARISSA NOWICKI ” Practice Location

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