Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.

Cowlitz Indian Tribe

Organization Public Health & General Preventive Medicine Physician · NPI 1225382328

Cowlitz Indian Tribe is a Public Health & General Preventive Medicine Physician in Tukwila, Washington. Works from 3 locations. Registered with an NPI since 2012.

In the registry since
2012
Specialties on file
4

Practice location Address checks out

15455 65th Ave S
Tukwila, WA 98188
Phone: (206) 721-5170
Fax: (206) 721-6288
Show map & directions

Pin is approximate — placed at the ZIP-code centre, not the exact door.

Additional practice locations (2)

  • 1000 Davis Pl, Dupont, WA 98327-8781 — (206) 721-5170
  • 6450 Southcenter Blvd, Tukwila, WA 98188-2552 — (206) 721-5170

Specialties & licences

Public Health & General Preventive Medicine Physician (primary) Taxonomy 2083P0901X
Clinic/Center Taxonomy 261Q00000X
Health Service Clinic/Center Taxonomy 261QH0100X
Mental Health Clinic/Center (Including Community Mental Health Center) Taxonomy 261QM0801X

Record details

NPI number1225382328
Entity typeOrganization (Type 2)
Organization subpartYes
Parent organizationCowlitz Indian Tribe
Authorized official Shavon Keller — Billing Supervisor · (360) 353-9431
Other names Cowlitz Tribal Health Services
NPI enumeratedOctober 29, 2012
Last updated in NPPESFebruary 3, 2023
Certification dateFebruary 3, 2023
Mailing addressPo Box 2429, Longview, WA 98632-8486