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General NPI Number Information
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NPI Number | 1003697087
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Entity Type | Organization
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Legal Business Name | MOUNTAIN SAGE MEDICINE, LLC
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Dates
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Enumeration Date | 10/06/2023
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Last Update Date | 01/17/2024
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Provider Practice Location Address
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Address Line | 107 W JEWETT BLVD STE 700
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City | WHITE SALMON
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State | WA
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Zip | 98672-8974
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Country | US
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Telephone | 509-808-6364
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Fax | 888-612-3925
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Provider Business Mailing Address
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Address Line | PO BOX 548
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City | WHITE SALMON
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State | WA
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Zip | 98672-0548
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Country | US
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Telephone | 509-808-6364
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Fax | 888-612-3925
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Authorized Official
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Title or Position | OWNER
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Name | DR. JENNIFER SILAPIE
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Credential | ND
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Telephone | 509-808-6364
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261Q00000X
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Taxonomy Name | Clinic/Center
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 175F00000X
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Taxonomy Name | Naturopath
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License Number |
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License Number State |
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