MEDICARE: MS. CAYLA M RAUH BS, 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
1	101YA0400X	Addiction (Substance Use Disorder) Counselor	60496772	WA
2	101YA0400X	Addiction (Substance Use Disorder) Counselor	60639402	WA

General Provider Information

NPI Number	:	1285089763
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. CAYLA M RAUH BS, SUDP

Provider Business Mailing Address
First Line	:	2171 SIDDLE LOOP UNIT 104
Second Line	:
City	:	FERNDALE
State	:	WA
Zip	:	98248-8632
Country	:	US
Telephone Number	:	360-880-7375
Fax Number	:

Provider Business Practice Location Address
First Line	:	1211 GIRARD ST
Second Line	:
City	:	BELLINGHAM
State	:	WA
Zip	:	98225-3219
Country	:	US
Telephone Number	:	360-397-8246
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/03/2016
Last Update Date	:	01/03/2023

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