Mandy Susanne Kieckhaben | Colorado Springs, CO • PECOS Search

Mandy Susanne Kieckhaben

Counselor

Behavioral Health & Social Service Providers

411 Lakewood Cir Ste C201, Colorado Springs, CO 80910-2668

PECOS Enrollment

Based on the most recent information from CMS, provider Mandy Susanne Kieckhaben does not have current enrollment records in PECOS.

Part B
Medicare Part B
Not Enrolled
HHA
Home Health Agency
Not Enrolled
DME
Durable Medical Equipment
Not Enrolled
PMD
Power Mobility Device
Not Enrolled

CMS last updated its PECOS records yesterday at 11:47 AM.

Profile Details

Provider ID
1881185940
Provider Type
Individual
Full Name
Kieckhaben, Mandy Susanne
Gender
Female

Sole Proprietor
Yes
Enumeration Date
5/24/2018
Last Updated
5/24/2018

Contact Information

Practice Location

411 Lakewood Cir Ste C201, Colorado Springs, CO 80910-2668

Unlisted Fax

Mailing Location

411 Lakewood Cir Ste C201, Colorado Springs, CO 80910-2668

Unlisted Fax

Provider Taxonomies

Code	Description	License
Code 101Y00000X Primary	Description Counselor Behavioral Health & Social Service Providers	License Unlisted Issuer