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MR. JACK ROBERT KRUSE SUDPT
NPI 1457987992
Student in an Organized Health Care Education/Training Program in Shoreline, WA

Active since March 17, 2020
16715 AURORA AVE N STE 102, SHORELINE, WA 98133(206) 546-9766(206) 542-0326 Get Directions Write a Review

NPPES record last updated: March 17, 2020. Verified against the NPPES registry weekly; last sync: August 02, 2026.

About Mr. Jack Robert Kruse Sudpt NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

MR. JACK ROBERT KRUSE SUDPT (NPI 1457987992) is an individual student in an organized health care education/training program in Shoreline, Washington and active in the NPI registry since March 2020.

NPPES Registry Identity

NPI1457987992
Entity TypeIndividualMale
Primary Taxonomy390200000X
Provider Legal NameMR. JACK ROBERT KRUSECredential: SUDPT
Location Address16715 AURORA AVE N STE 102Shoreline, WA 98133-5310
Mailing Address10514 Ne 144th StKirkland, WA 98034-5250 · (206) 384-7769
Phone(206) 546-9766
Fax(206) 542-0326
Sole ProprietorNo
Enumeration DateMarch 17, 2020
NPPES CertifiedMarch 17, 2020
✔ NPI 1457987992 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyStudent in an Organized Health Care Education/Training ProgramStudent, Health Care
Taxonomy Code390200000X
Definition
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.
16715 AURORA AVE N STE 102, Shoreline, WA 98133
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Other Providers at the Same Location NPPES 20

Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.

SONYA PATRCIA GIRTMAN
Counselor (Addiction (Substance Use Disorder))
16715 AURORA AVE N STE 102
SHORELINE, WA 98133
King County (206) 546-9766
NICHOLAS HANDWERK
Student in an Organized Health Care Education/Training Program
16715 AURORA AVE N STE 102
SHORELINE, WA 98133
King County (206) 546-9866
ANDREA KATHERINE ARANY-KOVACS SUDP
Counselor (Addiction (Substance Use Disorder))
16715 AURORA AVE N STE 102
SHORELINE, WA 98133
King County (206) 546-9766
KIMBERLY KAY OLATAWURA SUDPT
Counselor (Addiction (Substance Use Disorder))
16715 AURORA AVE N STE 102
SHORELINE, WA 98133
King County (206) 546-9766
MENBERE KIFLE
Counselor
16715 AURORA AVE N STE 102
SHORELINE, WA 98133
King County (206) 546-9766
MS. THERESA C BEI CDP
Counselor (Addiction (Substance Use Disorder))
16715 AURORA AVE N STE 102
SHORELINE, WA 98133
King County (206) 547-9766
THERAPEUTIC HEALTH SERVICES
Clinic/Center (Methadone)
16715 AURORA AVE N STE 102
SHORELINE, WA 98133
King County (206) 323-0930
KYLA LEONARD LWSAIC
Counselor
16715 AURORA AVE N STE 102
SHORELINE, WA 98133
King County (206) 546-9766

Frequently Asked Questions NPPES & CMS

Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.

What is Jack Kruse's NPI number?

The NPI number for Jack Kruse is 1457987992. It was assigned to this individual provider in the NPPES registry on March 17, 2020.

Where is Jack Kruse located?

Jack Kruse practices at 16715 Aurora Ave N Ste 102, Shoreline, WA 98133. The listed phone number is (206) 546-9766.

What is Jack Kruse's specialty?

The primary specialty registered for this NPI is Student in an Organized Health Care Education/Training Program with taxonomy code 390200000X.

When was this NPI record last updated?

The NPPES record for Jack Kruse was last updated on March 17, 2020. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 6 years ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.