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NPI Code Detail

MEDICARE: RYAN ALLYSON NOEL SUDP

MEDICARE: RYAN ALLYSON NOEL 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) CounselorCP60541153WA

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1922633031
Entity Type Code : Individual
Provider Name (Legal Business Name) : RYAN ALLYSON NOEL SUDP
Provider Business Mailing Address
First Line : 325 W GOWE ST
Second Line :
City : KENT
State : WA
Zip : 98032-5892
Country : US
Telephone Number : 253-833-7444
Fax Number : 253-735-9685
Provider Business Practice Location Address
First Line : 2704 I ST NE
Second Line :
City : AUBURN
State : WA
Zip : 98002-2411
Country : US
Telephone Number : 425-902-6902
Fax Number : 253-735-9685
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/09/2020
Last Update Date : 12/10/2025

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Directions to “ RYAN ALLYSON NOEL SUDP” Practice Location

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