Healthcare Provider Details

I. General information

NPI: 1972435832
Provider Name (Legal Business Name): RACHAEL THERESA CUDDY SUDP-T
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/02/2026
Last Update Date: 06/02/2026
Certification Date: 06/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2601 SUMMIT AVE BLDG A
EVERETT WA
98201-3309
US

IV. Provider business mailing address

1622 E MARINE VIEW DR APT J403
EVERETT WA
98201-2271
US

V. Phone/Fax

Practice location:
  • Phone: 425-258-2407
  • Fax:
Mailing address:
  • Phone: 425-493-5310
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License NumberCDPT.CO.70130086
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: