Healthcare Provider Details

I. General information

NPI: 1245867522
Provider Name (Legal Business Name): MADELINE FREEMAN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/25/2020
Last Update Date: 09/03/2026
Certification Date: 09/03/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

22 S THOR ST
SPOKANE WA
99202-4855
US

IV. Provider business mailing address

518 E 1ST ST
DEER PARK WA
99006-5421
US

V. Phone/Fax

Practice location:
  • Phone: 509-532-2000
  • Fax:
Mailing address:
  • Phone: 509-999-5657
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberMHCA.MC70085320
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: