Thomas Osterdahl, CDP

Individual provider Active NPI Addiction (Substance Use Disorder) Counselor · Edmonds, WA

NPI 1003387580 · NPPES record last updated Dec 10, 2018

Key facts

NPI
1003387580
Entity type
Individual (NPI type 1)
Primary specialty
Addiction (Substance Use Disorder) Counselor 101YA0400X
License
CP60725651 (WA)
Practice address
7935 Lake Ballinger Way
Edmonds, WA 98026-9166
Phone
(425) 412-2973
Fax
(425) 672-6022
NPI assigned
Dec 10, 2018
Sex
Male
Sole proprietor
Yes

Medicare participation

Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

Medicare enrollment (NPD)
No

State licenses

LicenseStateTypeSpecialty
CP60725651WAMDAddiction (Substance Use Disorder) Counselor

Specialties & licenses

Specialty (taxonomy)CodeLicenseStatePrimary
Addiction (Substance Use Disorder) Counselor
Group: 193400000X SINGLE SPECIALTY GROUP
101YA0400X CP60725651 WA Yes

Addresses

Primary practice location

7935 Lake Ballinger Way
Edmonds, WA 98026-9166

Mailing address

7935 Lake Ballinger Way
Edmonds, WA 98026-9166
Phone (425) 412-2973

Other providers in Edmonds, WA

All providers in Edmonds, WA · Addiction (Substance Use Disorder) Counselor in Washington

Sources for this page

Verify at the official NPI Registry.