Healthcare Provider Details

I. General information

NPI: 1184100125
Provider Name (Legal Business Name): SUSAN LOUISE AUVINEN SUDP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/12/2018
Last Update Date: 10/21/2024
Certification Date: 10/21/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

921 HARVEY RD NE STE C
AUBURN WA
98002-4294
US

IV. Provider business mailing address

921 HARVEY RD NE STE C
AUBURN WA
98002-4294
US

V. Phone/Fax

Practice location:
  • Phone: 253-939-2211
  • Fax: 253-939-2867
Mailing address:
  • Phone: 253-433-1701
  • Fax: 253-939-2867

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License NumberCP60673420
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: