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General NPI Number Information
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NPI Number | 1699321745
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Entity Type | Individual
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Provider Name | STEVE R OURADNIK
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Gender | Male
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Dates
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Enumeration Date | 08/14/2019
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Last Update Date | 08/14/2019
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Provider Practice Location Address
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Address Line | 3703 W KENNEWICK AVE APT D326
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City | KENNEWICK
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State | WA
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Zip | 99336-2883
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Country | US
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Telephone | 509-952-7501
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Fax |
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Provider Business Mailing Address
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Address Line | 3703 W KENNEWICK AVE APT D326
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City | KENNEWICK
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State | WA
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Zip | 99336-2883
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Country | US
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Telephone | 509-952-7501
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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 | CO60202575
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License Number State | WA
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