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General NPI Number Information
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NPI Number | 1699685669
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Entity Type | Individual
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Provider Name | JOHN BORJE LEONARDSON SUDPT
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Gender | Male
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Dates
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Enumeration Date | 09/10/2026
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Last Update Date | 09/10/2026
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Provider Practice Location Address
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Address Line | 1440 N HAVEN ST
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City | SPOKANE
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State | WA
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Zip | 99202-3674
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Country | US
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Telephone | 509-957-3310
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Fax |
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Provider Business Mailing Address
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Address Line | 1715 S HAYFORD RD APT 104F
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City | SPOKANE
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State | WA
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Zip | 99224-6024
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Country | US
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Telephone | 509-957-3310
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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 | CDPT.CO.70094538
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License Number State | WA
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