Healthcare Provider Details

I. General information

NPI: 1003768854
Provider Name (Legal Business Name): KELLY STRONK SUDPT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/13/2026
Last Update Date: 07/27/2026
Certification Date: 07/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3240 NORTHWEST AVE
BELLINGHAM WA
98225-1318
US

IV. Provider business mailing address

3240 NORTHWEST AVE
BELLINGHAM WA
98225-1318
US

V. Phone/Fax

Practice location:
  • Phone: 855-628-4509
  • Fax:
Mailing address:
  • Phone: 855-628-4509
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License NumberCDPT.CO.70085887
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: