Provider Demographics
NPI:1487830584
Name:REUST, KATHLEEN (LMP)
Entity Type:Individual
Prefix:
First Name:KATHLEEN
Middle Name:
Last Name:REUST
Suffix:
Gender:F
Credentials:LMP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4444 NE SUNSET BLVD
Mailing Address - Street 2:STE 2
Mailing Address - City:RENTON
Mailing Address - State:WA
Mailing Address - Zip Code:98059-4018
Mailing Address - Country:US
Mailing Address - Phone:425-255-2600
Mailing Address - Fax:425-266-2601
Practice Address - Street 1:16210 NE 11TH ST
Practice Address - Street 2:
Practice Address - City:BELLEVUE
Practice Address - State:WA
Practice Address - Zip Code:98008-3619
Practice Address - Country:US
Practice Address - Phone:425-818-4926
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-01-18
Last Update Date:2008-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA00005185174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist