Provider Demographics
NPI:1366253551
Name:SVENSON, RACHAEL LEE (SUDPT CO61625586)
Entity type:Individual
Prefix:
First Name:RACHAEL
Middle Name:LEE
Last Name:SVENSON
Suffix:
Gender:F
Credentials:SUDPT CO61625586
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4060 WHEATON WAY STE F
Mailing Address - Street 2:
Mailing Address - City:BREMERTON
Mailing Address - State:WA
Mailing Address - Zip Code:98310-3500
Mailing Address - Country:US
Mailing Address - Phone:405-863-4396
Mailing Address - Fax:
Practice Address - Street 1:19045 STATE HIGHWAY 305 NE STE 190
Practice Address - Street 2:
Practice Address - City:POULSBO
Practice Address - State:WA
Practice Address - Zip Code:98370-7312
Practice Address - Country:US
Practice Address - Phone:360-876-9430
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-01-16
Last Update Date:2025-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO61625586101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)