Provider Demographics
NPI:1669242913
Name:LEEDOM, ERIN (LSWAIC)
Entity type:Individual
Prefix:
First Name:ERIN
Middle Name:
Last Name:LEEDOM
Suffix:
Gender:F
Credentials:LSWAIC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:800 17TH ST
Mailing Address - Street 2:
Mailing Address - City:BELLINGHAM
Mailing Address - State:WA
Mailing Address - Zip Code:98225-6339
Mailing Address - Country:US
Mailing Address - Phone:602-571-0993
Mailing Address - Fax:
Practice Address - Street 1:1300 W HOLLY ST STE 202
Practice Address - Street 2:
Practice Address - City:BELLINGHAM
Practice Address - State:WA
Practice Address - Zip Code:98225-2952
Practice Address - Country:US
Practice Address - Phone:602-571-0993
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-01-08
Last Update Date:2024-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA612773191041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical