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NPI Code Detail

MEDICARE: PATRICIA RILEY SUDP

MEDICARE: PATRICIA RILEY 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) CounselorCO60535517WA
2101Y00000XCounselorCP60818469WA

General Provider Information

NPI Number : 1588023642
Entity Type Code : Individual
Provider Name (Legal Business Name) : PATRICIA RILEY SUDP
Provider Business Mailing Address
First Line : 6400 SOUTHCENTER BLVD
Second Line :
City : TUKWILA
State : WA
Zip : 98188-2547
Country : US
Telephone Number : 206-229-1238
Fax Number :
Provider Business Practice Location Address
First Line : 2329 4TH AVE
Second Line :
City : SEATTLE
State : WA
Zip : 98121-1717
Country : US
Telephone Number : 206-229-1238
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 02/17/2016
Last Update Date : 08/18/2020

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Directions to “ PATRICIA RILEY SUDP” Practice Location

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