Healthcare Provider Details

I. General information

NPI: 1598688731
Provider Name (Legal Business Name): LESLIE ZARAGOZA TAYLOR SUDPT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/03/2026
Last Update Date: 08/03/2026
Certification Date: 08/03/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10001 17TH PL S
SEATTLE WA
98168-1615
US

IV. Provider business mailing address

10001 17TH PL S
SEATTLE WA
98168-1615
US

V. Phone/Fax

Practice location:
  • Phone: 206-766-6969
  • Fax:
Mailing address:
  • Phone: 206-766-6969
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License NumberCDPT.CO.70104893
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: