Connie J Derus

Primary specialty

Professional CounselorTaxonomy code 101YP2500X

License

60303063 Issued in WA

Practice address

5133 Turkington Rd
Acme, WA 98220-9638

Phone

(206) 251-4776

NPI assigned

Jul 31, 2019

Sex

Female

Sole proprietor

Yes

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, last updated by the provider on Jul 31, 2019.

{
    "created_epoch": "1564531200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1564531200000",
    "number": "1821642406",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 98",
            "city": "ACME",
            "state": "WA",
            "postal_code": "982200098",
            "telephone_number": "206-251-4776"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5133 TURKINGTON RD",
            "city": "ACME",
            "state": "WA",
            "postal_code": "982209638",
            "telephone_number": "206-251-4776"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DERUS",
        "first_name": "CONNIE",
        "middle_name": "J",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2019-07-31",
        "last_updated": "2019-07-31",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YP2500X",
            "taxonomy_group": "",
            "desc": "Counselor, Professional",
            "state": "WA",
            "license": "60303063",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• County of Whatcom
• Margaret J Metcalfe, LMHC
• Sandra Lea Simon, MSPA.,CCC-SLP
• Whatcom County

• All providers in Acme, WA
• Professional Counselor in Washington

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 31, 2019; 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.