Provider Demographics
NPI:1023200292
Name:CONFEDERATED TRIBES AND BANDS OF THE YAKAMA NATION
Entity Type:Organization
Organization Name:CONFEDERATED TRIBES AND BANDS OF THE YAKAMA NATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PROGRAM MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:ELLEN
Authorized Official - Middle Name:M
Authorized Official - Last Name:SWAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:509-874-2979
Mailing Address - Street 1:401 FORD ROAD
Mailing Address - Street 2:
Mailing Address - City:TOPPENISH
Mailing Address - State:WA
Mailing Address - Zip Code:98948
Mailing Address - Country:US
Mailing Address - Phone:509-865-5121
Mailing Address - Fax:509-874-2113
Practice Address - Street 1:401 BUSTER ROAD
Practice Address - Street 2:
Practice Address - City:TOPPENISH
Practice Address - State:WA
Practice Address - Zip Code:98948
Practice Address - Country:US
Practice Address - Phone:509-874-2979
Practice Address - Fax:509-874-2113
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-08-13
Last Update Date:2008-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA7123243Medicaid