Healthcare Provider Details

I. General information

NPI: 1164021044
Provider Name (Legal Business Name): FREDERICK DYGERT, LCSW
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/21/2020
Last Update Date: 10/21/2020
Certification Date: 10/21/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1445 WILLAMETTE ST STE 2B
EUGENE OR
97401-4087
US

IV. Provider business mailing address

1430 WILLAMETTE ST # 608
EUGENE OR
97401-4049
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 TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State

VII. Legacy identifiers

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

VIII. Authorized Official

Name: FREDERICK DYGERT
Title or Position: OWNER
Credential: LCSW
Phone: 541-520-1679