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NPI Code Detail

MEDICARE: JULIE ANNE GREENE SUDP

MEDICARE: JULIE ANNE GREENE 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) Counselor61416256WA

General Provider Information

NPI Number : 1881729572
Entity Type Code : Individual
Provider Name (Legal Business Name) : JULIE ANNE GREENE SUDP
Provider Business Mailing Address
First Line : PO BOX 2429
Second Line :
City : LONGVIEW
State : WA
Zip : 98632-8486
Country : US
Telephone Number : 360-575-3314
Fax Number : 360-575-3314
Provider Business Practice Location Address
First Line : 15455 65TH AVE S
Second Line :
City : TUKWILA
State : WA
Zip : 98188-2534
Country : US
Telephone Number : 206-721-5170
Fax Number : 206-575-1950
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 02/22/2007
Last Update Date : 06/24/2024

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Directions to “ JULIE ANNE GREENE SUDP” Practice Location

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