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Organization
SNOQUALMIE INDIAN TRIBE
Active
Organization
SNOQUALMIE INDIAN TRIBE
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JEAN MEDINA (COMPLIANCE MANAGER)
(425) 831-5425
Entity
Organization
Contact information
Practice address
9575 ETHAN WADE WAY SE, SNOQUALMIE, WA 98065-9577
(425) 831-5425
(425) 831-5428
Mailing address
PO BOX 969, ATTN COMPLIANCE MANAGER, SNOQUALMIE, WA 98065-0969
(425) 831-5425
(425) 831-5428
Taxonomy
Speciality
Code
Description
License number
State
2083P0901X
Public Health & General Preventive Medicine Physician
Primary
—
NULL
2083P0901X
Public Health & General Preventive Medicine Physician
Primary
—
—
261QM0801X
Mental Health Clinic/Center (Including Community Mental Health Center)
—
NULL
261QR0405X
Substance Use Disorder Rehabilitation Clinic/Center
—
NULL
Other
Enumeration date
04/17/2019
Last updated
07/25/2022
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