Healthcare Provider Details

I. General information

NPI: 1104901941
Provider Name (Legal Business Name): JAMESTOWN S'KLALLAM TRIBE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/26/2006
Last Update Date: 04/15/2026
Certification Date: 04/15/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

526 S 9TH AVE
SEQUIM WA
98382-3626
US

IV. Provider business mailing address

526 S 9TH AVE
SEQUIM WA
98382-3626
US

V. Phone/Fax

Practice location:
  • Phone: 360-681-7755
  • Fax: 360-681-5999
Mailing address:
  • Phone: 360-681-7755
  • Fax: 360-681-5999

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QM2800X
TaxonomyMethadone Clinic
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code261QR0405X
TaxonomySubstance Use Disorder Rehabilitation Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: W. RON ALLEN
Title or Position: TRIBAL CHAIRMAN/EXECUTIVE DIRECTOR
Credential:
Phone: 360-683-1109