Provider Demographics
NPI:1689132458
Name:SADZEWICZ, EMMA MAE (CDPT)
Entity Type:Individual
Prefix:
First Name:EMMA
Middle Name:MAE
Last Name:SADZEWICZ
Suffix:
Gender:F
Credentials:CDPT
Other - Prefix:
Other - First Name:EMMA
Other - Middle Name:MAE
Other - Last Name:ADAMS
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:CDPT
Mailing Address - Street 1:17337 RESERVATION RD
Mailing Address - Street 2:
Mailing Address - City:LA CONNER
Mailing Address - State:WA
Mailing Address - Zip Code:98257-8802
Mailing Address - Country:US
Mailing Address - Phone:360-466-1024
Mailing Address - Fax:
Practice Address - Street 1:17337 RESERVATION RD
Practice Address - Street 2:
Practice Address - City:LA CONNER
Practice Address - State:WA
Practice Address - Zip Code:98257-8802
Practice Address - Country:US
Practice Address - Phone:360-466-1024
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-03-11
Last Update Date:2019-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAC060855058101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)