Healthcare Provider Details

I. General information

NPI: 1972226900
Provider Name (Legal Business Name): ANTHONY LIGREGNI
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/23/2022
Last Update Date: 09/11/2024
Certification Date: 09/11/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15383 S GRAVES RD
MULINO OR
97042-9789
US

IV. Provider business mailing address

15383 S GRAVES RD
MULINO OR
97042-9789
US

V. Phone/Fax

Practice location:
  • Phone: 360-727-1450
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberSC61561885
License Number StateWA

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: