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NPI Code Detail

MEDICARE: SCOTT PETRUSHKA

MEDICARE: SCOTT PETRUSHKA
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1101Y00000XCounselorCG61294683WA

General Provider Information

NPI Number : 1225771488
Entity Type Code : Individual
Provider Name (Legal Business Name) : SCOTT PETRUSHKA
Provider Business Mailing Address
First Line : 520 TERRY AVE UNIT 221
Second Line :
City : SEATTLE
State : WA
Zip : 98104-2286
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 2008 WESTLAKE AVE STE 100
Second Line :
City : SEATTLE
State : WA
Zip : 98121-2695
Country : US
Telephone Number : 206-999-2615
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 04/15/2022
Last Update Date : 01/22/2026

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Directions to “ SCOTT PETRUSHKA ” Practice Location

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