Provider Demographics
NPI:1033850474
Name:SUNDEW INTEGRATED RECOVERY PLLC
Entity Type:Organization
Organization Name:SUNDEW INTEGRATED RECOVERY PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:ANDREW
Authorized Official - Middle Name:
Authorized Official - Last Name:DZIKOWSKI
Authorized Official - Suffix:
Authorized Official - Credentials:ND, LAC, LMT, RN
Authorized Official - Phone:201-600-6817
Mailing Address - Street 1:5005 200TH ST SW STE 102
Mailing Address - Street 2:
Mailing Address - City:LYNNWOOD
Mailing Address - State:WA
Mailing Address - Zip Code:98036-6679
Mailing Address - Country:US
Mailing Address - Phone:425-224-7188
Mailing Address - Fax:949-250-6911
Practice Address - Street 1:5005 200TH ST SW STE 102
Practice Address - Street 2:
Practice Address - City:LYNNWOOD
Practice Address - State:WA
Practice Address - Zip Code:98036-6679
Practice Address - Country:US
Practice Address - Phone:425-224-7188
Practice Address - Fax:949-250-6911
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-04-07
Last Update Date:2022-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care
No261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health
No261QM2500XAmbulatory Health Care FacilitiesClinic/CenterMedical Specialty
No261QR0405XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation, Substance Use Disorder