Provider Demographics
NPI:1548409642
Name:SHEPPARD SALUSKY, PH.D., PLLC
Entity Type:Organization
Organization Name:SHEPPARD SALUSKY, PH.D., PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEMBER
Authorized Official - Prefix:DR
Authorized Official - First Name:SHEPPARD
Authorized Official - Middle Name:
Authorized Official - Last Name:SALUSKY
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:206-285-6915
Mailing Address - Street 1:1800 WESTLAKE AVE N
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98109-2704
Mailing Address - Country:US
Mailing Address - Phone:206-285-6915
Mailing Address - Fax:206-285-1139
Practice Address - Street 1:1800 WESTLAKE AVE N
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98109-2704
Practice Address - Country:US
Practice Address - Phone:206-285-6915
Practice Address - Fax:206-285-1139
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-02-12
Last Update Date:2009-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA1014261QM0801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)