1659721371 NPI number — MRS. CARISSA MARIE SAWICKI MA, LPC

Table of content: MRS. CARISSA MARIE SAWICKI MA, LPC (NPI 1659721371)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1659721371 NPI number — MRS. CARISSA MARIE SAWICKI MA, LPC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
SAWICKI
Provider First Name:
CARISSA
Provider Middle Name:
MARIE
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
MA, LPC
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
GUTSMIEDL
Provider Other First Name:
CARISSA
Provider Other Middle Name:
MARIE
Provider Other Name Prefix Text:
MS.
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1659721371
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
02/15/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1870 W 122ND AVE STE 100
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
WESTMINSTER
Provider Business Mailing Address State Name:
CO
Provider Business Mailing Address Postal Code:
80234-2075
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
240-371-0259
Provider Business Mailing Address Fax Number:
303-853-3702

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1850 E EGBERT ST STE 200
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
BRIGHTON
Provider Business Practice Location Address State Name:
CO
Provider Business Practice Location Address Postal Code:
80601-2484
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
303-853-3500
Provider Business Practice Location Address Fax Number:
303-853-3702
Provider Enumeration Date:
06/14/2016

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 101YM0800X , with the licence number:  7938-125 , registered in the state of WI ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 101YP2500X , with the licence number: LPC.0018023 , registered in the state of CO ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 376001106006 , issued by the state of ( IL ) . This identifiers is of the category "MEDICAID".
  • Identifier: 100103270 , issued by the state of ( WI ) . This identifiers is of the category "MEDICAID".
  • Identifier: 376001106007 , issued by the state of ( IL ) . This identifiers is of the category "MEDICAID".