Individual provider Active NPI

Wendy Roseann Bates, CDP

  • Addiction (Substance Use Disorder) Counselor
  • Everett, WA
National Provider Identifier
1104079037
Registry record updated Oct 22, 2008
On this page

Key facts

NPPES NPI Registry
Primary specialty
Addiction (Substance Use Disorder) CounselorTaxonomy code 101YA0400X
License
CP00004316 Issued in WA
Practice address
1918 Everett Ave
Everett, WA 98201-3607
Phone
(425) 258-5270
Fax
(425) 258-5275
NPI assigned
Oct 22, 2008
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Oct 22, 2008

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Addiction (Substance Use Disorder) Counselor 101YA0400X CP00004316 WA Primary

Addresses

Primary practice location

1918 Everett Ave
Everett, WA 98201-3607

Mailing address

30709 82ND Ave NW
Stanwood, WA 98292-9751
Phone (360) 629-0290

Other identifiers 1

IdentifierTypeStateIssuer
00004316OtherWACHEMICAL DEPENDENCY PROFESSIONAL

Medicare participation

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

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Not enrolled

State licenses

LicenseStateTypeSpecialty
CP00004316WAMDAddiction (Substance Use Disorder) Counselor

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1224633600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1224633600000",
    "number": "1104079037",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "30709 82ND AVE NW",
            "city": "STANWOOD",
            "state": "WA",
            "postal_code": "982929751",
            "telephone_number": "360-629-0290"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1918 EVERETT AVE",
            "city": "EVERETT",
            "state": "WA",
            "postal_code": "982013607",
            "telephone_number": "425-258-5270",
            "fax_number": "425-258-5275"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BATES",
        "first_name": "WENDY",
        "middle_name": "ROSEANN",
        "name_prefix": "Ms.",
        "credential": "CDP",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2008-10-22",
        "last_updated": "2008-10-22",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YA0400X",
            "taxonomy_group": "",
            "desc": "Counselor, Addiction (Substance Use Disorder)",
            "state": "WA",
            "license": "CP00004316",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "CHEMICAL DEPENDENCY PROFESSIONAL",
            "identifier": "00004316",
            "state": "WA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Everett, WA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 22, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.