Healthcare Provider Details

I. General information

NPI: 1003697087
Provider Name (Legal Business Name): MOUNTAIN SAGE MEDICINE, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/06/2023
Last Update Date: 01/17/2024
Certification Date: 01/17/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

107 W JEWETT BLVD STE 700
WHITE SALMON WA
98672-8974
US

IV. Provider business mailing address

PO BOX 548
WHITE SALMON WA
98672-0548
US

V. Phone/Fax

Practice location:
  • Phone: 509-808-6364
  • Fax: 888-612-3925
Mailing address:
  • Phone: 509-808-6364
  • Fax: 888-612-3925

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code175F00000X
TaxonomyNaturopath
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number
License Number State

VIII. Authorized Official

Name: DR. JENNIFER SILAPIE
Title or Position: OWNER
Credential: ND
Phone: 509-808-6364