Healthcare Provider Details

I. General information

NPI: 1932995479
Provider Name (Legal Business Name): ERICA BUNDY SUDPT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/18/2025
Last Update Date: 04/18/2025
Certification Date: 04/18/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

701 E 3RD AVE
SPOKANE WA
99202-6014
US

IV. Provider business mailing address

953 E 35TH AVE
SPOKANE WA
99203-3163
US

V. Phone/Fax

Practice location:
  • Phone: 509-838-6092
  • Fax:
Mailing address:
  • Phone: 509-558-9367
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number61625574
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: