Healthcare Provider Details

I. General information

NPI: 1598385007
Provider Name (Legal Business Name): NOEMI STEPHANIE OCAMPO BA / SUDPT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/24/2020
Last Update Date: 04/24/2020
Certification Date: 04/24/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

22026 20TH AVE SE STE 101
BOTHELL WA
98021-4449
US

IV. Provider business mailing address

22026 20TH AVE SE STE 101
BOTHELL WA
98021-4449
US

V. Phone/Fax

Practice location:
  • Phone: 425-672-7293
  • Fax: 425-329-4640
Mailing address:
  • Phone: 425-672-7293
  • Fax: 425-329-4640

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License NumberCO60997213
License Number StateWA

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: