Healthcare Provider Details

I. General information

NPI: 1457265530
Provider Name (Legal Business Name): JOSHUA DAVID KOSTELYK CC
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/28/2026
Last Update Date: 09/28/2026
Certification Date: 09/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2628 W PLYMOUTH ST
SEATTLE WA
98199-4125
US

IV. Provider business mailing address

2628 W PLYMOUTH ST
SEATTLE WA
98199-4125
US

V. Phone/Fax

Practice location:
  • Phone: 206-755-3050
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License NumberCCC.CL.70172371
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: