Kelley Jean Brusoe

Primary specialty

Addiction (Substance Use Disorder) CounselorTaxonomy code 101YA0400X

License

CO60571280 Issued in WA

Practice address

1210 SW 136TH St
Burien, WA 98166-1214

Phone

(206) 257-6757

NPI assigned

Oct 9, 2018

Last updated

Oct 9, 2018By the provider in NPPES

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1539043200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1539043200000",
    "number": "1659846319",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3717 148TH ST SW APT C101",
            "city": "LYNNWOOD",
            "state": "WA",
            "postal_code": "980875537",
            "telephone_number": "920-530-7189"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1210 SW 136TH ST",
            "city": "BURIEN",
            "state": "WA",
            "postal_code": "981661214",
            "telephone_number": "206-257-6757"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BRUSOE",
        "first_name": "KELLEY",
        "middle_name": "JEAN",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2018-10-09",
        "last_updated": "2018-10-09",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YA0400X",
            "taxonomy_group": "",
            "desc": "Counselor, Addiction (Substance Use Disorder)",
            "state": "WA",
            "license": "CO60571280",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Timothy James Brennan, OPTICIAN
• Alexa Marie Bricker, RN
• Madeline Miranda Bristol, NP
• Kenya Marie Broadnax
• Caitlin Mercedes Brown, LMP
• Barbara Lynn Bryant, CCC-SLP
• My Phuong Thi Bui, O.D.
• Jill Bujnevicie, PA
• Kiranmayi Bulusu, M.D.
• Diane Bunch, ARNP

• Addiction (Substance Use Disorder) Counselor in Burien, WA
• Providers in Burien, WA by specialty
• Addiction (Substance Use Disorder) Counselor in Washington

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 9, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.