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General NPI Number Information
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NPI Number | 1639780620
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Entity Type | Individual
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Provider Name | JAYNELLE KOPP SUDP
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Gender | Female
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Dates
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Enumeration Date | 08/12/2020
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Last Update Date | 07/29/2025
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Provider Practice Location Address
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Address Line | 7700 NE 26TH AVE
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City | VANCOUVER
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State | WA
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Zip | 98665-0672
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Country | US
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Telephone | 360-397-8228
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Fax | 360-353-9440
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Provider Business Mailing Address
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Address Line | PO BOX 2429
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City | LONGVIEW
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State | WA
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Zip | 98632-8486
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Country | US
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Telephone | 360-353-9494
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Fax | 360-353-9440
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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 | 10850
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License Number State | CA
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Taxonomy #2
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Taxonomy Code | 101YA0400X
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Taxonomy Name | Addiction (Substance Use Disorder) Counselor
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License Number | CP61346560
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License Number State | WA
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