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General NPI Number Information
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NPI Number | 1598339129
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Entity Type | Individual
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Provider Name | TAMMY JEAN BACIGALUPO SUDPT
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Gender | Female
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Dates
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Enumeration Date | 05/18/2021
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Last Update Date | 05/18/2021
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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 | 360-972-2152
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Provider Business Mailing Address
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Address Line | 31 E BLEVINS RD S
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City | SHELTON
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State | WA
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Zip | 98584-9106
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Country | US
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Telephone | 360-281-8868
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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 |
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License Number State |
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