MEDICARE: IRIS SPRING SEPE SUDP

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
1	101YA0400X	Addiction (Substance Use Disorder) Counselor

General Provider Information

NPI Number	:	1528541679
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	IRIS SPRING SEPE SUDP

Provider Business Mailing Address
First Line	:	8809 3RD AVE S BSMT APT
Second Line	:
City	:	SEATTLE
State	:	WA
Zip	:	98108-4506
Country	:	US
Telephone Number	:	425-247-5579
Fax Number	:

Provider Business Practice Location Address
First Line	:	11000 LAKE CITY WAY NE
Second Line	:
City	:	SEATTLE
State	:	WA
Zip	:	98125-6748
Country	:	US
Telephone Number	:	206-483-8124
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/13/2018
Last Update Date	:	01/30/2026

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