Healthcare Provider Details

I. General information

NPI: 1588343651
Provider Name (Legal Business Name): ABIGAIL THOMPSON SUDP-&
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/14/2023
Last Update Date: 02/07/2024
Certification Date: 02/07/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11711 E SPRAGUE AVE
SPOKANE VALLEY WA
99206
US

IV. Provider business mailing address

11711 E SPRAGUE AVE
SPOKANE VALLEY WA
99206-6126
US

V. Phone/Fax

Practice location:
  • Phone: 509-927-6838
  • Fax:
Mailing address:
  • Phone: 208-582-6253
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License NumberCO61448190
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License NumberCO61448190
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: