Healthcare Provider Details

I. General information

NPI: 1992203343
Provider Name (Legal Business Name): YALONDA SMITH SUDP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/30/2018
Last Update Date: 10/21/2025
Certification Date: 10/21/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

312 W 8TH AVE
SPOKANE WA
99204-2506
US

IV. Provider business mailing address

312 W 8TH AVE
SPOKANE WA
99204-2506
US

V. Phone/Fax

Practice location:
  • Phone: 509-324-3619
  • Fax:
Mailing address:
  • Phone: 509-324-3619
  • Fax: 509-327-0163

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License NumberCP60933448
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: