Provider Demographics
NPI:1760104939
Name:SLUSHER, BREEANNA (MC61356639)
Entity Type:Individual
Prefix:
First Name:BREEANNA
Middle Name:
Last Name:SLUSHER
Suffix:
Gender:F
Credentials:MC61356639
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2014 201ST ST E
Mailing Address - Street 2:
Mailing Address - City:SPANAWAY
Mailing Address - State:WA
Mailing Address - Zip Code:98387-4110
Mailing Address - Country:US
Mailing Address - Phone:417-771-1936
Mailing Address - Fax:
Practice Address - Street 1:615 E PIONEER STE 204
Practice Address - Street 2:
Practice Address - City:PUYALLUP
Practice Address - State:WA
Practice Address - Zip Code:98372-3320
Practice Address - Country:US
Practice Address - Phone:253-848-3891
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-09-14
Last Update Date:2022-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMC61356639101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health