Provider Demographics
NPI:1528749215
Name:BIESECKER, MICHELLE
Entity type:Individual
Prefix:
First Name:MICHELLE
Middle Name:
Last Name:BIESECKER
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 1:1355 GARDEN OF THE GODS RD STE 150
Mailing Address - Street 2:
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80907-3595
Mailing Address - Country:US
Mailing Address - Phone:719-212-6535
Mailing Address - Fax:719-212-6539
Practice Address - Street 1:2828 JANITELL RD
Practice Address - Street 2:
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80906-4141
Practice Address - Country:US
Practice Address - Phone:719-820-1567
Practice Address - Fax:719-623-0377
Is Sole Proprietor?:No
Enumeration Date:2023-07-26
Last Update Date:2025-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CORBT-23-286657106S00000X
RBT-23-286657222Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes222Q00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersDevelopmental Therapist
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician