Provider Demographics
NPI:1730260977
Name:FREELAND, RUSSELL C (EDD)
Entity type:Individual
Prefix:DR
First Name:RUSSELL
Middle Name:C
Last Name:FREELAND
Suffix:
Gender:M
Credentials:EDD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:650 OFFICERS ROW
Mailing Address - Street 2:
Mailing Address - City:VANCOUVER
Mailing Address - State:WA
Mailing Address - Zip Code:98661-3836
Mailing Address - Country:US
Mailing Address - Phone:360-695-3012
Mailing Address - Fax:360-574-6979
Practice Address - Street 1:650 OFFICERS ROW
Practice Address - Street 2:
Practice Address - City:VANCOUVER
Practice Address - State:WA
Practice Address - Zip Code:98661-3836
Practice Address - Country:US
Practice Address - Phone:360-695-3012
Practice Address - Fax:360-574-6979
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-17
Last Update Date:2009-07-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA573103TB0200X
OR412103TB0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TB0200XBehavioral Health & Social Service ProvidersPsychologistCognitive & Behavioral