Healthcare Provider Details

I. General information

NPI: 1821916065
Provider Name (Legal Business Name): KALA BROOD SUDPT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: KALA RAINS SUDPT

II. Dates (important events)

Enumeration Date: 07/07/2026
Last Update Date: 07/07/2026
Certification Date: 07/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2026 DIVISION ST # 100
BELLINGHAM WA
98226-8058
US

IV. Provider business mailing address

2026 DIVISION ST # 100
BELLINGHAM WA
98226-8058
US

V. Phone/Fax

Practice location:
  • Phone: 360-812-7220
  • Fax: 844-807-0646
Mailing address:
  • Phone: 360-812-7220
  • Fax: 844-807-0646

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License NumberCO70103600
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: