Healthcare Provider Details

I. General information

NPI: 1336129295
Provider Name (Legal Business Name): UPPER SKAGIT INDIAN TRIBE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/18/2006
Last Update Date: 07/28/2025
Certification Date: 07/28/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

25959 COMMUNITY PLAZA WAY
SEDRO WOOLLEY WA
98284-9721
US

IV. Provider business mailing address

25944 COMMUNITY PLAZA WAY
SEDRO WOOLLEY WA
98284-9721
US

V. Phone/Fax

Practice location:
  • Phone: 360-854-7070
  • Fax: 360-854-7060
Mailing address:
  • Phone: 360-854-7070
  • Fax: 360-854-7060

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License NumberCP00001654
License Number StateWA
# 2
Primary TaxonomyN
Taxonomy Code103TC1900X
TaxonomyCounseling Psychologist
License Number;H00008445
License Number StateWA
# 3
Primary TaxonomyN
Taxonomy Code104100000X
TaxonomySocial Worker
License NumberRC00047287
License Number StateWA
# 4
Primary TaxonomyN
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License NumberDI00001414
License Number StateWA
# 5
Primary TaxonomyN
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License NumberLP00022558
License Number StateWA
# 6
Primary TaxonomyN
Taxonomy Code208600000X
TaxonomySurgery Physician
License NumberMD00012663
License Number StateWA
# 7
Primary TaxonomyN
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License NumberMD00012663
License Number StateWA
# 8
Primary TaxonomyY
Taxonomy Code261QF0400X
TaxonomyFederally Qualified Health Center (FQHC)
License Number
License Number StateWA
# 9
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAP30006120
License Number StateWA

VIII. Authorized Official

Name: MS. MARILYN M SCOTT
Title or Position: TRIBAL VICE-CHAIRMAN
Credential:
Phone: 360-854-7039