Healthcare Provider Details

I. General information

NPI: 1902737851
Provider Name (Legal Business Name): HANNAH GAVETTE SUDPT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: HANNAH IPOCK SUDPT

II. Dates (important events)

Enumeration Date: 05/28/2026
Last Update Date: 05/28/2026
Certification Date: 05/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1302 COMMERCE AVE
LONGVIEW WA
98632-3096
US

IV. Provider business mailing address

1302 COMMERCE AVE
LONGVIEW WA
98632-3096
US

V. Phone/Fax

Practice location:
  • Phone: 360-423-2806
  • Fax: 360-423-5128
Mailing address:
  • Phone: 360-423-2806
  • Fax: 360-423-5128

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License NumberCO0030132
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: