Provider Demographics
NPI:1710112982
Name:DUDLEY, TAMARA A
Entity Type:Individual
Prefix:
First Name:TAMARA
Middle Name:A
Last Name:DUDLEY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:207 N LEWIS ST
Mailing Address - Street 2:
Mailing Address - City:ABERDEEN
Mailing Address - State:WA
Mailing Address - Zip Code:98520-7632
Mailing Address - Country:US
Mailing Address - Phone:360-276-4405
Mailing Address - Fax:360-276-4104
Practice Address - Street 1:1505 KLA-OOK-WA DRIVE
Practice Address - Street 2:
Practice Address - City:TAHOLAH
Practice Address - State:WA
Practice Address - Zip Code:98587-0219
Practice Address - Country:US
Practice Address - Phone:360-276-4405
Practice Address - Fax:360-276-4104
Is Sole Proprietor?:No
Enumeration Date:2009-05-18
Last Update Date:2009-05-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WARC 00040793101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor