Provider Demographics
NPI:1457736878
Name:HRESKO, ELLEN
Entity Type:Individual
Prefix:
First Name:ELLEN
Middle Name:
Last Name:HRESKO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:321 HIGH SCHOOL RD NE # 733D3
Mailing Address - Street 2:
Mailing Address - City:BAINBRIDGE ISLAND
Mailing Address - State:WA
Mailing Address - Zip Code:98110-2647
Mailing Address - Country:US
Mailing Address - Phone:206-458-1695
Mailing Address - Fax:
Practice Address - Street 1:321 HIGH SCHOOL RD NE # 733D3
Practice Address - Street 2:
Practice Address - City:BAINBRIDGE ISLAND
Practice Address - State:WA
Practice Address - Zip Code:98110-2647
Practice Address - Country:US
Practice Address - Phone:206-458-1695
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-07-27
Last Update Date:2023-09-20
Deactivation Date:2019-07-23
Deactivation Code:
Reactivation Date:2023-09-11
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist