Healthcare Provider Details

I. General information

NPI: 1689975633
Provider Name (Legal Business Name): FREDERICK M DYGERT LCSW
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/08/2010
Last Update Date: 05/30/2025
Certification Date: 05/30/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1711 WILLAMETTE ST STE 2
EUGENE OR
97401-4014
US

IV. Provider business mailing address

242 CANARY AVE
CRESWELL OR
97426-9879
US

V. Phone/Fax

Practice location:
  • Phone: 541-520-1679
  • Fax:
Mailing address:
  • Phone: 541-520-1679
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number97-04-19
License Number StateOR
# 2
Primary TaxonomyN
Taxonomy Code104100000X
TaxonomySocial Worker
License NumberA2316
License Number StateOR
# 3
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberL5227
License Number StateOR

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: