MEDICARE: MICHAEL JAWORSKI LPC, CADC

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	101YA0400X	Addiction (Substance Use Disorder) Counselor	12447	WI
2	101YP2500X	Professional Counselor	1206-125	WI

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1861413130
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MICHAEL JAWORSKI LPC, CADC

Provider Business Mailing Address
First Line	:	285 N JANACEK RD
Second Line	:
City	:	BROOKFIELD
State	:	WI
Zip	:	53045-6102
Country	:	US
Telephone Number	:	262-641-9050
Fax Number	:	262-641-9126

Provider Business Practice Location Address
First Line	:	2314 N GRANDVIEW BLVD
Second Line	:	SUITES 301 AND 110
City	:	WAUKESHA
State	:	WI
Zip	:	53188-1675
Country	:	US
Telephone Number	:	262-524-9416
Fax Number	:	262-524-9434

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

Provider Enumeration Date	:	07/22/2006
Last Update Date	:	11/30/2007

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