Individual
KELLEY JEAN BRUSOE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
1210 SW 136TH ST, BURIEN, WA 98166-1214
(206) 257-6757
Mailing address
3717 148TH ST SW APT C101, LYNNWOOD, WA 98087-5537
(920) 530-7189
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
CO60571280
WA
Other
Enumeration date
10/09/2018
Last updated
10/09/2018
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