Healthcare Provider Details

I. General information

NPI: 1750024535
Provider Name (Legal Business Name): MELISSA JO SCHMIDT SUDPT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/19/2022
Last Update Date: 09/29/2026
Certification Date: 09/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1001 N J ST
TACOMA WA
98403-2125
US

IV. Provider business mailing address

9720 S TACOMA WAY
LAKEWOOD WA
98499-4456
US

V. Phone/Fax

Practice location:
  • Phone: 253-830-6242
  • Fax:
Mailing address:
  • Phone: 253-604-7422
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License NumberCDPT.CO.61627553
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: