Healthcare Provider Details

I. General information

NPI: 1205301736
Provider Name (Legal Business Name): DESIREE REUSCH
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/11/2018
Last Update Date: 06/19/2026
Certification Date: 06/19/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

545 W STEVENS RD UNIT 101
BURLINGTON WA
98233-3438
US

IV. Provider business mailing address

545 W STEVENS RD UNIT 101
BURLINGTON WA
98233-3438
US

V. Phone/Fax

Practice location:
  • Phone: 909-268-1887
  • Fax:
Mailing address:
  • Phone: 909-268-1887
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number110652
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: