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NPI Code Detail

MEDICARE: GARY L BREDEWEG MSW

MEDICARE: GARY L BREDEWEG MSW
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1104100000XSocial WorkerL1500OR

General Provider Information

NPI Number : 1558454454
Entity Type Code : Individual
Provider Name (Legal Business Name) : GARY L BREDEWEG MSW
Provider Business Mailing Address
First Line : PO BOX 100
Second Line :
City : ALBANY
State : OR
Zip : 97321-0031
Country : US
Telephone Number : 541-967-3866
Fax Number : 541-928-3020
Provider Business Practice Location Address
First Line : 445 3RD AVE SW
Second Line :
City : ALBANY
State : OR
Zip : 97321-2272
Country : US
Telephone Number : 541-967-3866
Fax Number : 541-928-3020
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 10/02/2006
Last Update Date : 07/08/2007

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Directions to “ GARY L BREDEWEG MSW” Practice Location

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