Samantha Joann Wynn, SUDPT
Individual provider Active NPI Addiction (Substance Use Disorder) Counselor · Cusick, WA
NPI 1720628167 · NPPES record last updated Jan 14, 2020
Key facts
- NPI
- 1720628167
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Addiction (Substance Use Disorder) Counselor 101YA0400X
- License
- CO60982388 (WA)
- Practice address
- 808 Community Hall Rd
Cusick, WA 99119-6034 - Phone
- (509) 447-7193
- NPI assigned
- Jan 14, 2020
- Sex
- Female
- Sole proprietor
- No
Organizations & group practices 1
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| CO60982388 | WA | MD | Addiction (Substance Use Disorder) Counselor |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Kalispel Tribe-Camas Institute | Past |
Accepting new patients |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Addiction (Substance Use Disorder) Counselor | 101YA0400X | CO60982388 | WA | Yes |
Addresses
Primary practice location
808 Community Hall Rd
Cusick, WA 99119-6034
Mailing address
934 S Garfield Rd
Airway Heights, WA 99001-9030
Phone (509) 447-7193
Electronic endpoints
| Type | Endpoint | Use | Affiliation |
|---|---|---|---|
| CONNECT URL | Cusick |
Other providers in Cusick, WA
- April R Sattleen
- Dillon Raymond Seeber
- Jennifer Marie Tackitt
- James Douglas Volk
- Anita Toyo Waterman
All providers in Cusick, WA · Addiction (Substance Use Disorder) Counselor in Washington
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jan 14, 2020. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.