MEDICARE: JENNIFER GAZAWAY LPCC

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	101YP2500X	Professional Counselor	LPC.0020113	CO

General Provider Information

NPI Number	:	1952182487
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JENNIFER GAZAWAY LPCC

Provider Business Mailing Address
First Line	:	1283 KELLY JOHNSON BLVD
Second Line	:
City	:	COLORADO SPRINGS
State	:	CO
Zip	:	80920-3925
Country	:	US
Telephone Number	:	719-452-4803
Fax Number	:

Provider Business Practice Location Address
First Line	:	1283 KELLY JOHNSON BLVD
Second Line	:
City	:	COLORADO SPRINGS
State	:	CO
Zip	:	80920-3925
Country	:	US
Telephone Number	:	719-452-4803
Fax Number	:

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

Provider Enumeration Date	:	10/10/2023
Last Update Date	:	03/09/2026

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