Healthcare Provider Details

I. General information

NPI: 1326956616
Provider Name (Legal Business Name): HOLLY JOHANNA RICE SUDPT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/28/2026
Last Update Date: 08/28/2026
Certification Date: 08/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2924 FALK RD
VANCOUVER WA
98661-5604
US

IV. Provider business mailing address

5203 NW LINCOLN AVE
VANCOUVER WA
98663-1537
US

V. Phone/Fax

Practice location:
  • Phone: 360-690-3069
  • Fax: 360-726-5961
Mailing address:
  • Phone: 503-784-6014
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number70142209
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: