Provider Demographics
NPI:1013788447
Name:WOITTE, SHAWN MICHEAL (SUDPT)
Entity Type:Individual
Prefix:
First Name:SHAWN
Middle Name:MICHEAL
Last Name:WOITTE
Suffix:
Gender:M
Credentials:SUDPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1000 SE 160TH AVE APT EE254
Mailing Address - Street 2:
Mailing Address - City:VANCOUVER
Mailing Address - State:WA
Mailing Address - Zip Code:98683-9608
Mailing Address - Country:US
Mailing Address - Phone:360-852-5772
Mailing Address - Fax:
Practice Address - Street 1:5197 NW LOWER RIVER RD # ITA
Practice Address - Street 2:
Practice Address - City:VANCOUVER
Practice Address - State:WA
Practice Address - Zip Code:98660-1013
Practice Address - Country:US
Practice Address - Phone:360-205-1222
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-01-15
Last Update Date:2024-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA175T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175T00000XOther Service ProvidersPeer Specialist