Basic Information
| Provider Information | |||||||||
| NPI: | 1396100855 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | FREETO | ||||||||
| FirstName: | AMY | ||||||||
| MiddleName: | JEAN | ||||||||
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| Mailing Information | |||||||||
| Address1: | 24 SWEETCLOVER CIR | ||||||||
| Address2: | |||||||||
| City: | BELLINGHAM | ||||||||
| State: | WA | ||||||||
| PostalCode: | 982294442 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3604414351 | ||||||||
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| Practice Location | |||||||||
| Address1: | 231 SE BARRINGTON DR STE 203 | ||||||||
| Address2: | |||||||||
| City: | OAK HARBOR | ||||||||
| State: | WA | ||||||||
| PostalCode: | 982773200 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8662400808 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 12/28/2015 | ||||||||
| LastUpdateDate: | 12/30/2015 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 103K00000X | BACB326846 | WA | Y | Behavioral Health & Social Service Providers | Behavioral Analyst |
No ID Information.