Healthcare Provider Details

I. General information

NPI: 1992418107
Provider Name (Legal Business Name): MS. ELLEN GRYJ-RUBENSTEIN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/03/2023
Last Update Date: 06/03/2025
Certification Date: 06/03/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

17018 15TH AVE NE
SHORELINE WA
98155-5137
US

IV. Provider business mailing address

17018 15TH AVE NE
SHORELINE WA
98155-5137
US

V. Phone/Fax

Practice location:
  • Phone: 206-362-7282
  • Fax:
Mailing address:
  • Phone: 206-362-7282
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberMC61477808
License Number StateWA
# 2
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: