Provider Demographics
NPI:1336884147
Name:KUCYK, MEREDITH RACHEL LEIGH (LSW, MSW, ADDC)
Entity Type:Individual
Prefix:MRS
First Name:MEREDITH
Middle Name:RACHEL LEIGH
Last Name:KUCYK
Suffix:
Gender:F
Credentials:LSW, MSW, ADDC
Other - Prefix:
Other - First Name:MEREDITH
Other - Middle Name:RACHEL LEIGH
Other - Last Name:BIRD
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2802 COUNTRY CLUB CIR
Mailing Address - Street 2:
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80909-1017
Mailing Address - Country:US
Mailing Address - Phone:720-237-7240
Mailing Address - Fax:
Practice Address - Street 1:2802 COUNTRY CLUB CIR
Practice Address - Street 2:
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80909-1017
Practice Address - Country:US
Practice Address - Phone:720-237-7240
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-05-05
Last Update Date:2023-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COADDC.0000274101YA0400X
COLSW.00099245741041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)