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NPI Code Detail

MEDICARE: BOZENA DRABIK SUDP

MEDICARE: BOZENA DRABIK SUDP
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1101YA0400XAddiction (Substance Use Disorder) CounselorCP60342266WA

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1013395094
Entity Type Code : Individual
Provider Name (Legal Business Name) : BOZENA DRABIK SUDP
Provider Business Mailing Address
First Line : 1057 12TH AVE
Second Line :
City : LONGVIEW
State : WA
Zip : 98632-2509
Country : US
Telephone Number : 360-274-3262
Fax Number :
Provider Business Practice Location Address
First Line : 2232 S SILVER LAKE RD
Second Line :
City : CASTLE ROCK
State : WA
Zip : 98611-8021
Country : US
Telephone Number : 360-274-3262
Fax Number : 360-274-3345
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/11/2015
Last Update Date : 03/22/2024

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Directions to “ BOZENA DRABIK SUDP” Practice Location

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