Healthcare Provider Details

I. General information

NPI: 1467842229
Provider Name (Legal Business Name): ERIC GORDON HUFFMAN MSW, LICSW
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/02/2015
Last Update Date: 02/02/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

19520 66TH AVE W
LYNNWOOD WA
98036-5163
US

IV. Provider business mailing address

19520 66TH AVE W
LYNNWOOD WA
98036-5163
US

V. Phone/Fax

Practice location:
  • Phone: 425-773-2899
  • Fax:
Mailing address:
  • Phone: 425-773-2899
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberLW00007638
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: