Healthcare Provider Details

I. General information

NPI: 1871461574
Provider Name (Legal Business Name): SKYLEE MARIE LUJAN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/25/2025
Last Update Date: 10/25/2025
Certification Date: 10/22/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

950 BROADWAY ST SUITE 301
TACOMA WA
98402
US

IV. Provider business mailing address

6101 HARRY SMITH RD E 6101 HARRY SMITH RD E
FIFE WA
98424
US

V. Phone/Fax

Practice location:
  • Phone: 253-671-9909
  • Fax:
Mailing address:
  • Phone: 253-307-6964
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License NumberBACB1459074
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: