Provider Demographics
NPI:1639680531
Name:LENCZYCKI, KAILEE M
Entity type:Individual
Prefix:
First Name:KAILEE
Middle Name:M
Last Name:LENCZYCKI
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2501 CHATHAM RD # 5424
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:IL
Mailing Address - Zip Code:62704-4188
Mailing Address - Country:US
Mailing Address - Phone:970-432-4515
Mailing Address - Fax:970-585-8704
Practice Address - Street 1:5655 S YOSEMITE ST STE 350
Practice Address - Street 2:
Practice Address - City:GREENWOOD VILLAGE
Practice Address - State:CO
Practice Address - Zip Code:80111-3222
Practice Address - Country:US
Practice Address - Phone:970-432-4515
Practice Address - Fax:970-585-8704
Is Sole Proprietor?:No
Enumeration Date:2017-10-18
Last Update Date:2024-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COAPN.0993553-NP363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health