Individual provider · Type 1 NPI

Jack Robert Kruse, SUDPT

Student in an Organized Health Care Education/Training Program · Shoreline, WA

NPI number 1457987992 Active

Practice location

16715 Aurora Ave N Ste 102
Shoreline, WA 98133-5310

Call (206) 546-9766 Map

Fax (206) 542-0326

Mailing address

10514 NE 144th St
Kirkland, WA 98034-5250

Specialties and licenses

TaxonomyCodeLicense
Student in an Organized Health Care Education/Training Program Primary 390200000XNone listed

Student in an Organized Health Care Education/Training Program: An individual who is enrolled in an organized health care education/training program leading to a degree, certification, registration, and/or licensure to provide health care.

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About NPI 1457987992

Jack Robert Kruse, SUDPT's National Provider Identifier is 1457987992, issued on Mar 17, 2020. The primary taxonomy on file is Student in an Organized Health Care Education/Training Program (390200000X), and the practice location is in Shoreline, WA. The record was last updated on Mar 17, 2020.