MR. JEREMIAH SHANE DUNLAP SUDP NPI 1336515964

NPI Information

NPI: 1336515964
Provider Name: MR. JEREMIAH SHANE DUNLAP, SUDP
Classification: Counselor - 101YA0400X
Entity Type: Individual

Specialization: Addiction (Substance Use Disorder)

Address:
4909 108TH ST SW
LAKEWOOD, WA
ZIP 98499
Phone: (253) 544-4772
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MR. Jeremiah Shane Dunlap, SUDP is an addiction (substance use disorder) counselor in Lakewood, WA. MR. Jeremiah Shane Dunlap, SUDP NPI is 1336515964. The provider is registered as an individual entity type.

The NPPES NPI record indicates the provider is a male.

The provider's business location address is:

4909 108TH ST SW
LAKEWOOD, WA
ZIP 98499-724
Phone: (253) 544-4772
Fax: (253) 276-0042

The enumeration date for this NPI number is 8/18/2015 and was last updated on 1/24/2023.

Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No.	Taxonomy Code	Taxonomy Clasification	Taxonomy Specialization	License Number	License State	Primary
1	101YM0800X	Counselor	Mental Health	CP60556714	WASHINGTON	No
2	101YA0400X	Counselor	Addiction (Substance Use Disorder)	CP60556714	WASHINGTON	Yes

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

No.	Other Provider Identifier	Other Provider Identifier Type	Other Provider Identifier State	Other Provider Identifier Issuer
1	CP60556714	OTHER	WASHINGTON	CHEMICAL DEPENDANCY PROFESSIONAL
2	41614	MEDICAID	WASHINGTON

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 5/5/2024

NPI Synchronization or Removal

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