Healthcare Provider Details

I. General information

NPI: 1679444574
Provider Name (Legal Business Name): EMILIE ANNE ESCOBAR SUDPT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/15/2025
Last Update Date: 09/15/2025
Certification Date: 09/15/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1601 E COLLEGE WAY
MOUNT VERNON WA
98273-5612
US

IV. Provider business mailing address

2530 CENTRAL RD
EVERSON WA
98247-9759
US

V. Phone/Fax

Practice location:
  • Phone: 360-763-5595
  • Fax:
Mailing address:
  • Phone: 360-303-9697
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License NumberCO70034686
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: