Healthcare Provider Details

I. General information

NPI: 1427898683
Provider Name (Legal Business Name): ETHAN FRECKLETON LSWAIC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/27/2024
Last Update Date: 07/11/2026
Certification Date: 07/11/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1329 N STATE ST STE 212
BELLINGHAM WA
98225-4754
US

IV. Provider business mailing address

1329 N STATE ST STE 212
BELLINGHAM WA
98225-4754
US

V. Phone/Fax

Practice location:
  • Phone: 360-510-1211
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberSWIA.SC.70129726
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: