Healthcare Provider Details

I. General information

NPI: 1659280964
Provider Name (Legal Business Name): MAKAYLA JAMES SUDPT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/02/2026
Last Update Date: 09/02/2026
Certification Date: 09/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

506 W FRANKLIN ST
SHELTON WA
98584-3517
US

IV. Provider business mailing address

PO BOX 59
CHEHALIS WA
98532-0059
US

V. Phone/Fax

Practice location:
  • Phone: 360-427-5232
  • Fax: 360-740-1877
Mailing address:
  • Phone: 360-740-4380
  • Fax: 360-740-1877

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License NumberCO70041695
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: