Healthcare Provider Details

I. General information

NPI: 1972363109
Provider Name (Legal Business Name): LOUELLA FAITH BAKER I SUDP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: LOUELLA FAITH COOK

II. Dates (important events)

Enumeration Date: 03/22/2024
Last Update Date: 10/09/2026
Certification Date: 03/22/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6330 31ST AVE NE STE 101
TULALIP WA
98271-7423
US

IV. Provider business mailing address

6330 31ST AVE NE STE 101
TULALIP WA
98271-7423
US

V. Phone/Fax

Practice location:
  • Phone: 360-716-2200
  • Fax: 360-716-2211
Mailing address:
  • Phone: 360-716-2200
  • Fax: 360-716-2211

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License NumberCO61490048
License Number StateWA
# 2
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License NumberCP70059761
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: