Provider Demographics
NPI:1124355466
Name:SAUCIER, JEREMIAH THUNDERWALKER (SUDP)
Entity type:Individual
Prefix:MR
First Name:JEREMIAH
Middle Name:THUNDERWALKER
Last Name:SAUCIER
Suffix:
Gender:M
Credentials:SUDP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8717 S HOSMER ST
Mailing Address - Street 2:
Mailing Address - City:TACOMA
Mailing Address - State:WA
Mailing Address - Zip Code:98444-1819
Mailing Address - Country:US
Mailing Address - Phone:253-473-7474
Mailing Address - Fax:
Practice Address - Street 1:8717 S HOSMER ST
Practice Address - Street 2:
Practice Address - City:TACOMA
Practice Address - State:WA
Practice Address - Zip Code:98444-1819
Practice Address - Country:US
Practice Address - Phone:253-473-7474
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-11-06
Last Update Date:2022-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WACO60117863101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Provider Identifiers
StateIdentifier IDID TypeIssuer
WACO60117863OtherWASHINGTON STATE DEPARTMENT OF HEALTH
WARC60098609OtherWA STATE DEPARTMENT OF HEALTH