Healthcare Provider Details

I. General information

NPI: 1285265520
Provider Name (Legal Business Name): PHILIP AARON O'CONNELL SUDP
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/27/2020
Last Update Date: 10/05/2026
Certification Date: 10/05/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

515 3RD AVE
SEATTLE WA
98104-2304
US

IV. Provider business mailing address

7228 61ST PL NE
MARYSVILLE WA
98270-8869
US

V. Phone/Fax

Practice location:
  • Phone: 206-464-1570
  • Fax:
Mailing address:
  • Phone: 425-923-5879
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License NumberCP61299143
License Number StateWA
# 3
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License NumberSC.70063734
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: