Healthcare Provider Details

I. General information

NPI: 1932025269
Provider Name (Legal Business Name): KRISTY NARDOZZI SUDP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/29/2026
Last Update Date: 06/30/2026
Certification Date: 06/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8514 W GAGE BLVD STE G
KENNEWICK WA
99336-8108
US

IV. Provider business mailing address

8514 W GAGE BLVD STE G
KENNEWICK WA
99336-8108
US

V. Phone/Fax

Practice location:
  • Phone: 509-524-9903
  • Fax: 888-745-2096
Mailing address:
  • Phone: 509-524-9903
  • Fax: 888-745-2096

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License NumberCP.61587817
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: