Provider Demographics
NPI:1194470013
Name:KRAWCZYK, JOSH (SUDP-T)
Entity Type:Individual
Prefix:
First Name:JOSH
Middle Name:
Last Name:KRAWCZYK
Suffix:
Gender:M
Credentials:SUDP-T
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:20226 20TH PL NE
Mailing Address - Street 2:
Mailing Address - City:SHORELINE
Mailing Address - State:WA
Mailing Address - Zip Code:98155-1308
Mailing Address - Country:US
Mailing Address - Phone:206-250-9212
Mailing Address - Fax:
Practice Address - Street 1:1116 SUMMIT AVE
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98101-2831
Practice Address - Country:US
Practice Address - Phone:206-726-4100
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-02-18
Last Update Date:2022-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA61256558390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program