Healthcare Provider Details

I. General information

NPI: 1235967902
Provider Name (Legal Business Name): ARYN ELDRIDGE LICSWA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/24/2024
Last Update Date: 06/13/2025
Certification Date: 06/13/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7424 BRIDGEPORT WAY W STE 305
LAKEWOOD WA
98499-8135
US

IV. Provider business mailing address

PO BOX 11331
OLYMPIA WA
98508-1331
US

V. Phone/Fax

Practice location:
  • Phone: 253-246-6820
  • Fax:
Mailing address:
  • Phone: 561-315-7087
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberSC61578133
License Number StateWA
# 2
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License NumberSC61578133
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: