Provider Demographics
NPI:1396144788
Name:FIELDSTAD, ERIN
Entity type:Individual
Prefix:
First Name:ERIN
Middle Name:
Last Name:FIELDSTAD
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:272 FROGNER RD
Mailing Address - Street 2:
Mailing Address - City:CHEHALIS
Mailing Address - State:WA
Mailing Address - Zip Code:98532-9142
Mailing Address - Country:US
Mailing Address - Phone:360-791-7478
Mailing Address - Fax:
Practice Address - Street 1:272 FROGNER RD
Practice Address - Street 2:
Practice Address - City:CHEHALIS
Practice Address - State:WA
Practice Address - Zip Code:98532-9142
Practice Address - Country:US
Practice Address - Phone:360-791-7478
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-08-21
Last Update Date:2014-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMURPHEC303DS101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health