MEDICARE: KIMBERLY R WESTOM 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	CDP.CP61301194	WA

General Provider Information

NPI Number	:	1801753207
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KIMBERLY R WESTOM SUDP

Provider Business Mailing Address
First Line	:	2815 EASTLAKE AVE E STE 100
Second Line	:
City	:	SEATTLE
State	:	WA
Zip	:	98102-3086
Country	:	US
Telephone Number	:	206-707-7580
Fax Number	:	206-341-9917

Provider Business Practice Location Address
First Line	:	2815 EASTLAKE AVE E STE 100
Second Line	:
City	:	SEATTLE
State	:	WA
Zip	:	98102-3086
Country	:	US
Telephone Number	:	206-707-7580
Fax Number	:	206-341-9917

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

Provider Enumeration Date	:	01/07/2026
Last Update Date	:	01/07/2026

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