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NPI Code Detail

MEDICARE: MICHELE SMITH SUDPT

MEDICARE: MICHELE SMITH SUDPT
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1101YA0400XAddiction (Substance Use Disorder) CounselorCO61100369WA

General Provider Information

NPI Number : 1285849257
Entity Type Code : Individual
Provider Name (Legal Business Name) : MICHELE SMITH SUDPT
Provider Business Mailing Address
First Line : PO BOX 1207
Second Line :
City : YAKIMA
State : WA
Zip : 98907-1207
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 201 E LINCOLN AVE STE 100
Second Line :
City : YAKIMA
State : WA
Zip : 98901-2348
Country : US
Telephone Number : 509-457-5653
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/13/2007
Last Update Date : 03/15/2022

Similar Medicare Providers

1740755016 — MS. ALYSSA M CHANEY SUDP
Practice Location Address:
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1396210662 — MRS. MEAGAN A TAKAMORI SUDP
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1154840122 — JAMES E BARTH CP00001342
Practice Location Address:
201 E LINCOLN AVE STE 100
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1992270268 — MR. GERARD Z DOMBROWSKI CDP
Practice Location Address:
201 E LINCOLN AVE STE 100
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Practice Fax: 509-457-3107

Directions to “ MICHELE SMITH SUDPT” Practice Location

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