Provider Demographics
NPI:1598259889
Name:ANTENEN, ERIN ANN CLOUTHIER (LICSW)
Entity Type:Individual
Prefix:
First Name:ERIN
Middle Name:ANN CLOUTHIER
Last Name:ANTENEN
Suffix:
Gender:F
Credentials:LICSW
Other - Prefix:
Other - First Name:ERIN
Other - Middle Name:ANN
Other - Last Name:CLOUTHIER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LSW
Mailing Address - Street 1:1106 HARRIS AVE STE 210
Mailing Address - Street 2:
Mailing Address - City:BELLINGHAM
Mailing Address - State:WA
Mailing Address - Zip Code:98225-7001
Mailing Address - Country:US
Mailing Address - Phone:360-920-6472
Mailing Address - Fax:
Practice Address - Street 1:1106 HARRIS AVE STE 210
Practice Address - Street 2:
Practice Address - City:BELLINGHAM
Practice Address - State:WA
Practice Address - Zip Code:98225-7001
Practice Address - Country:US
Practice Address - Phone:360-920-6472
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-06-19
Last Update Date:2020-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WALW608418881041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA2105843Medicaid