Healthcare Provider Details

I. General information

NPI: 1710249560
Provider Name (Legal Business Name): AHYONDA KYEE WARR SUDP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/07/2012
Last Update Date: 07/22/2021
Certification Date: 07/22/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4240 AUBURN WAY N
AUBURN WA
98002-1311
US

IV. Provider business mailing address

6400 SOUTHCENTER BLVD
TUKWILA WA
98188-2547
US

V. Phone/Fax

Practice location:
  • Phone: 253-876-8900
  • Fax:
Mailing address:
  • Phone: 206-901-2041
  • Fax: 253-798-2935

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License NumberCO60285375
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: