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General NPI Number Information
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NPI Number | 1073173969
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Entity Type | Individual
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Provider Name | SAMANTHA MARIE GILBERTSON CDPT
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Gender | Female
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Dates
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Enumeration Date | 06/13/2019
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Last Update Date | 08/21/2019
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Provider Practice Location Address
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Address Line | 200 LILLY RD NE STE C
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City | OLYMPIA
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State | WA
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Zip | 98506-5080
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Country | US
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Telephone | 360-918-8336
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Fax |
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Provider Business Mailing Address
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Address Line | 18945 PRAIRIE ST SW
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City | ROCHESTER
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State | WA
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Zip | 98579-9232
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Country | US
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Telephone | 360-529-9711
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YA0400X
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Taxonomy Name | Addiction (Substance Use Disorder) Counselor
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License Number | CO60950585
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License Number State | WA
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