Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 101YA0400X | Addiction Counselor (Substance Use Disorder) | CP60725651 | WA |
NPI | 1003387580 |
---|---|
Provider Name | Thomas Osterdahl |
First Address | Edmonds, WA 98026-9166 |
Second Address | Edmonds, WA 98026-9166 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 10/12/2018 |
Last Update Date | 10/12/2018 |