Provider Demographics
NPI:1992517692
Name:ISENBARGER, COURTNEY ANN (SUDPT)
Entity type:Individual
Prefix:
First Name:COURTNEY
Middle Name:ANN
Last Name:ISENBARGER
Suffix:
Gender:F
Credentials:SUDPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6219 PARKER RD E # UNITY13
Mailing Address - Street 2:
Mailing Address - City:SUMNER
Mailing Address - State:WA
Mailing Address - Zip Code:98390-2867
Mailing Address - Country:US
Mailing Address - Phone:253-363-6627
Mailing Address - Fax:
Practice Address - Street 1:12201 PACIFIC AVE S
Practice Address - Street 2:
Practice Address - City:TACOMA
Practice Address - State:WA
Practice Address - Zip Code:98444-5126
Practice Address - Country:US
Practice Address - Phone:253-444-2395
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-01-21
Last Update Date:2025-01-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WACO61522905101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)