MEDICARE: STILLAGUAMISH TRIBE OF INDIANS

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	251S00000X	Community/Behavioral Health Agency

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

General Provider Information

NPI Number	:	1508919168
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	STILLAGUAMISH TRIBE OF INDIANS

Provider Business Mailing Address
First Line	:	5700 172ND ST NE STE B
Second Line	:
City	:	ARLINGTON
State	:	WA
Zip	:	98223-7742
Country	:	US
Telephone Number	:	360-435-3985
Fax Number	:	360-435-7941

Provider Business Practice Location Address
First Line	:	5700 172ND ST NE SUITE B
Second Line	:
City	:	ARLINGTON
State	:	WA
Zip	:	98223
Country	:	US
Telephone Number	:	360-435-3985
Fax Number	:	360-435-7941

Authorized Official
Title or Position	:	ADMINISTRATIVE OPERATIONS MANAGER
Name	:	ROBBI JEAN BRYSON
Credential	:
Telephone Number	:	360-435-3985

Provider Enumeration Date	:	01/18/2007
Last Update Date	:	02/02/2026

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