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NPI Code Detail

MEDICARE: KAMIMSA JOSEPHINE GOUDY SUDPT

MEDICARE: KAMIMSA JOSEPHINE GOUDY SUDPT
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
1104100000XSocial WorkerSWIA.SC.70050873WA
2101YA0400XAddiction (Substance Use Disorder) CounselorCDP.CP.70042901WA
3171M00000XCase Manager/Care CoordinatorWA

General Provider Information

NPI Number : 1538843818
Entity Type Code : Individual
Provider Name (Legal Business Name) : KAMIMSA JOSEPHINE GOUDY SUDPT
Provider Business Mailing Address
First Line : 1655 CAMPBELL RD
Second Line :
City : WAPATO
State : WA
Zip : 98951-9558
Country : US
Telephone Number : 509-910-2848
Fax Number :
Provider Business Practice Location Address
First Line : 402 S 4TH AVE
Second Line :
City : YAKIMA
State : WA
Zip : 98902-3546
Country : US
Telephone Number : 509-575-4084
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/15/2023
Last Update Date : 06/12/2026

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