Provider Demographics
NPI:1891919197
Name:SALUSKY, SHEPPARD (PHD)
Entity Type:Individual
Prefix:DR
First Name:SHEPPARD
Middle Name:
Last Name:SALUSKY
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:DR
Other - First Name:SHEPPARD
Other - Middle Name:
Other - Last Name:SALUSKY
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PHD, PLLC
Mailing Address - Street 1:1800 WESTLAKE AVE N
Mailing Address - Street 2:SUITE 305
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:205-285-1139
Practice Address - Street 1:1800 WESTLAKE AVE N
Practice Address - Street 2:SUITE 305
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:205-285-1139
Is Sole Proprietor?:No
Enumeration Date:2007-04-11
Last Update Date:2009-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA1014103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
G217000298Medicare UPIN