Healthcare Provider Details

I. General information

NPI: 1801753207
Provider Name (Legal Business Name): KIMBERLY R WESTOM SUDP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/07/2026
Last Update Date: 01/07/2026
Certification Date: 01/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2815 EASTLAKE AVE E STE 100
SEATTLE WA
98102-3086
US

IV. Provider business mailing address

2815 EASTLAKE AVE E STE 100
SEATTLE WA
98102-3086
US

V. Phone/Fax

Practice location:
  • Phone: 206-707-7580
  • Fax: 206-341-9917
Mailing address:
  • Phone: 206-707-7580
  • Fax: 206-341-9917

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License NumberCDP.CP61301194
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: