Provider Demographics
NPI:1275214215
Name:SKAGGS, DONALD SELAVY
Entity Type:Individual
Prefix:
First Name:DONALD
Middle Name:SELAVY
Last Name:SKAGGS
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7831 NE 150TH ST
Mailing Address - Street 2:
Mailing Address - City:KENMORE
Mailing Address - State:WA
Mailing Address - Zip Code:98028-4686
Mailing Address - Country:US
Mailing Address - Phone:707-362-6262
Mailing Address - Fax:
Practice Address - Street 1:12220 113TH AVE NE STE 210
Practice Address - Street 2:
Practice Address - City:KIRKLAND
Practice Address - State:WA
Practice Address - Zip Code:98034-6950
Practice Address - Country:US
Practice Address - Phone:425-502-5641
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-07-31
Last Update Date:2023-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA1982342101Medicaid