Ethan Oftedahl

Primary specialty

Peer SpecialistTaxonomy code 175T00000X

License

837 Issued in ND

Practice address

921 2ND Ave S
Fargo, ND 58103-1705

Phone

(701) 361-9922

Fax

(701) 829-7140

NPI assigned

Feb 20, 2026

Sex

Unspecified or another gender identity

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Light House Recovery Services

  • Community/Behavioral Health Agency
  • Fargo, ND
  • NPI 1144920828
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1771545600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1771545600000",
    "number": "1003769779",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "921 2ND AVE S",
            "city": "FARGO",
            "state": "ND",
            "postal_code": "581031705",
            "telephone_number": "701-361-9922",
            "fax_number": "701-829-7140"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "921 2ND AVE S",
            "city": "FARGO",
            "state": "ND",
            "postal_code": "581031705",
            "telephone_number": "701-361-9922",
            "fax_number": "701-829-7140"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "OFTEDAHL",
        "first_name": "ETHAN",
        "sole_proprietor": "NO",
        "sex": "X",
        "enumeration_date": "2026-02-20",
        "last_updated": "2026-02-20",
        "certification_date": "2026-02-20",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "175T00000X",
            "taxonomy_group": "",
            "desc": "Peer Specialist",
            "state": "ND",
            "license": "837",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Deb Odegard, COTA/L
• Oluwatobi Ezekiel Odetola, MBBS
• Krista Lee Odili
• Megan Odland, OTR/L
• Barbara Ann Oemcke, RD, CDE
• Katelyn Ogburn
• Nicole Ogren
• Ty Ogren
• Chinelo Christine Okigbo, PHD, MD, MPH
• Andrea M Oknick, RRT

• Peer Specialist in Fargo, ND
• Providers in Fargo, ND by specialty
• Peer Specialist in North Dakota

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 20, 2026; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.