Provider Demographics
NPI:1366924250
Name:MYCZKOWIAK, KACEE MARIE (SWLC)
Entity type:Individual
Prefix:MISS
First Name:KACEE
Middle Name:MARIE
Last Name:MYCZKOWIAK
Suffix:
Gender:F
Credentials:SWLC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1820 6TH ST W
Mailing Address - Street 2:
Mailing Address - City:BILLINGS
Mailing Address - State:MT
Mailing Address - Zip Code:59102-3604
Mailing Address - Country:US
Mailing Address - Phone:989-245-0966
Mailing Address - Fax:
Practice Address - Street 1:1750 RAY OF HOPE LN
Practice Address - Street 2:
Practice Address - City:BILLINGS
Practice Address - State:MT
Practice Address - Zip Code:59106-3502
Practice Address - Country:US
Practice Address - Phone:406-656-2198
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-09-06
Last Update Date:2024-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6801102705101YM0800X
MTBBH-SWLC-LIC-38990101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health