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General NPI Number Information
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NPI Number | 1366253551
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Entity Type | Individual
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Provider Name | RACHAEL LEE SVENSON SUDPT CO61625586
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Gender | Female
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Dates
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Enumeration Date | 01/16/2025
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Last Update Date | 01/16/2025
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Provider Practice Location Address
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Address Line | 19045 STATE HIGHWAY 305 NE STE 190
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City | POULSBO
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State | WA
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Zip | 98370-7312
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Country | US
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Telephone | 360-876-9430
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Fax |
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Provider Business Mailing Address
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Address Line | 4060 WHEATON WAY STE F
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City | BREMERTON
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State | WA
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Zip | 98310-3500
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Country | US
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Telephone | 405-863-4396
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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 | CO61625586
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License Number State |
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