MEDICARE: CASCADE FUNCTIONAL MEDICINE, P.S.

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
1	207Q00000X	Family Medicine Physician	601417908	WA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	601417908	OTHER	WA	UBI # STATE OF WA
3	50D0988185	OTHER	WA	CORP CLIA #

General Provider Information

NPI Number	:	1063622355
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CASCADE FUNCTIONAL MEDICINE, P.S.

Provider Business Mailing Address
First Line	:	16500 SE 15TH ST STE 100
Second Line	:
City	:	VANCOUVER
State	:	WA
Zip	:	98683-9666
Country	:	US
Telephone Number	:	360-254-4402
Fax Number	:	360-892-9241

Provider Business Practice Location Address
First Line	:	16500 SE 15TH ST STE 100
Second Line	:
City	:	VANCOUVER
State	:	WA
Zip	:	98683-9666
Country	:	US
Telephone Number	:	360-254-4402
Fax Number	:	360-892-9241

Authorized Official
Title or Position	:	OWNER/PHYSICIAN
Name	:	SHERILYN MARIE FOLTZ-COOK
Credential	:	D.O.
Telephone Number	:	360-254-4402

Provider Enumeration Date	:	05/23/2007
Last Update Date	:	03/31/2026

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