Provider Demographics
NPI:1689234023
Name:RUST, ANNE MARIE
Entity Type:Individual
Prefix:
First Name:ANNE
Middle Name:MARIE
Last Name:RUST
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:ANNE
Other - Middle Name:MARIE
Other - Last Name:VOGT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:BA PSYCHOLOGY
Mailing Address - Street 1:3625 C ST
Mailing Address - Street 2:
Mailing Address - City:BREMERTON
Mailing Address - State:WA
Mailing Address - Zip Code:98312-4616
Mailing Address - Country:US
Mailing Address - Phone:360-265-5923
Mailing Address - Fax:
Practice Address - Street 1:3213 W. WHEELER ST.
Practice Address - Street 2:#302
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98199
Practice Address - Country:US
Practice Address - Phone:206-453-4882
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-06-18
Last Update Date:2019-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician