Healthcare Provider Details

I. General information

NPI: 1114658317
Provider Name (Legal Business Name): CHRISTINA ANN MALONE SUDPT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/20/2022
Last Update Date: 06/20/2022
Certification Date: 06/20/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1321 N ASH ST
SPOKANE WA
99201-2803
US

IV. Provider business mailing address

1321 N ASH ST
SPOKANE WA
99201-2803
US

V. Phone/Fax

Practice location:
  • Phone: 509-327-3120
  • Fax: 509-327-3228
Mailing address:
  • Phone: 509-327-3120
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License NumberCO61251116
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: