Mr. Jack Robert Kruse, SUDPT
Mr. Jack Robert Kruse, SUDPT is a Student in an Organized Health Care Education/Training Program in Shoreline, Washington. Licensed in Washington. Registered with an NPI since 2020.
- Licensed in
- WA
- In the registry since
- 2020
Practice location Address checks out
16715 Aurora Ave N Ste 102Shoreline, WA 98133-5310
Phone: (206) 546-9766
Fax: (206) 542-0326
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Specialties & licences
| Student in an Organized Health Care Education/Training Program (primary) | Taxonomy 390200000X (WA) |
|---|
Record details
| NPI number | 1457987992 |
|---|---|
| Entity type | Individual (Type 1) |
| Gender | Male |
| Credentials | SUDPT |
| Sole proprietor | No |
| NPI enumerated | March 17, 2020 |
| Last updated in NPPES | March 17, 2020 |
| Certification date | March 17, 2020 |
| Mailing address | 10514 Ne 144th St, Kirkland, WA 98034-5250 |
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