Healthcare Provider Details

I. General information

NPI: 1023779667
Provider Name (Legal Business Name): DANIRA M CUEN SANCHEZ CO61177127
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/05/2022
Last Update Date: 01/06/2022
Certification Date: 01/06/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

21810 NE 37TH AVE
RIDGEFIELD WA
98642-7747
US

IV. Provider business mailing address

21810 NE 37TH AVE
RIDGEFIELD WA
98642-7747
US

V. Phone/Fax

Practice location:
  • Phone: 844-777-9242
  • Fax: 360-397-7477
Mailing address:
  • Phone: 844-777-9242
  • Fax: 360-397-7477

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code175T00000X
TaxonomyPeer Specialist
License NumberCG61259469
License Number StateWA
# 2
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License NumberCO61177127
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: