Independent US Healthcare Provider Directory & Public Medical Database
Active NPI 1003769779 Individual Practitioner

Ethan Oftedahl

Peer Specialist • Fargo, ND

Professional Overview & Biography Verified Profile Summary

Ethan Oftedahl is a registered healthcare professional specializing in Peer Specialist in Fargo, ND. Practice services are available at 921 2ND AVE S under active NPI credentials.

Practice Location & Contact Primary Location

Practice Address

921 2nd Ave S

Fargo, ND 581031705

Telephone 7013619922
Fax 7018297140
Associated Practice Facility / Clinic
🏢 Light House Recovery Services Facility NPI 1144920828

Specialty Benchmarks & Practice Insights

Comparative analytics for Peer Specialist in Fargo, ND

Active Practitioner
Practitioner Clinical Experience
Active
City Avg: 10.5 Yrs
State Avg: 10.2 Yrs
Regional Practice Density
108 Specialists

Practicing in Fargo, ND (296 Statewide)

Telehealth Adoption Rate
0.0% Regional Adoption

In-Person Office Visits Only

Medicare Pricing Discount
67.4% Avg Savings

Under CMS Medicare Fee Schedule vs Standard Submitted Charges

Medical Specialties & State Licenses

CMS Verified: 2026-02-20
Peer Specialist Primary Specialty

NUCC Taxonomy Code: 175T00000X

State License ND 837

Individuals certified to perform peer support services through a training process defined by a government agency, such as the Department of Veterans Affairs or a state mental health department/certification/licensing authority.

Practice Associates & Co-Workers

Healthcare professionals and specialists practicing at this location or sharing practice phone/fax

18 Associated Practitioners
Kris Strouse

Peer Specialist

NPI 1073394144
Rachel Goerke

Case Manager/Care Coordinator

NPI 1114803558
Millennium Falcon

Peer Specialist

NPI 1144918723
Shane Kayeska

Peer Specialist

NPI 1174218473
Jamie Mabe

Peer Specialist

NPI 1245911346
Nicholas Senn

Peer Specialist

NPI 1336011519

Career & Practice History Timeline

Chronological log of verified NPI updates, location relocations, credentials, and registry changes

6 Historical Events
NPI Profile Active February 20, 2026

NPI status registered as active in NPPES database

📍
Updated Practice Location February 20, 2026

Registered at 921 2ND AVE S, FARGO, ND 581031705 (Tel: 7013619922)

📍
Updated Business Mailing Address February 20, 2026

Registered at 921 2ND AVE S, FARGO, ND 581031705 (Tel: 7013619922)

👤
Provider Name / Credentials Updated February 20, 2026

Recorded as ETHAN OFTEDAHL

🎓
Medical Taxonomy / Specialty Registered (Primary Specialty) February 20, 2026

Peer Specialist (License #837 in ND)

🟢
Initial NPI Registration & Enumeration February 20, 2026

First registered as active Individual Practitioner in NPPES Database.

Patient & Community Reviews

Verified patient ratings, medical care experiences, and facility photos

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NPI Administrative Meta

NPI Number: 1003769779
Entity Type:
Individual Provider Physician, Nurse Practitioner, or Solo Healthcare Professional (Type 1 NPI)
Enumeration Date: February 20, 2026
Last Update: February 20, 2026
Sole Proprietor: No

Mailing Address

921 2nd Ave S

Fargo, ND 581031705

Phone: 7013619922

Public Domain Record This profile contains public domain information published by CMS and NPPES under the Freedom of Information Act (FOIA).
⚠️ Medical Disclaimer

This directory listing is for informational purposes only and does not constitute medical advice, diagnosis, or physician endorsement. If you are experiencing a medical emergency, please call 911 immediately.