Fredrickson, Mick
Fredrickson, Mick is an sole proprietor health care provider with primary practice located at 425 2Nd Ave Sw Ste 102 , Albany OR 97321-2483. He recently has only one registered license in Behavioral Health & Social Service Providers / Clinical, which is considered as his primary health care specialty. Fredrickson, Mick can be contacted via phone (541) 286-3209.Contact Information
Primary practice address
425 2Nd Ave Sw Ste 102
Albany OR 97321-2483
Phone: (541) 286-3209
Fax: (541) 704-0040
Website:
Health care specialties
| Specialty | Code | License # | State |
|---|---|---|---|
| Behavioral Health & Social Service Providers / Clinical | 1041C0700X | L6743 | Oregon |
Profile Details
| NPI number | 1104180520 |
|---|---|
| LBN Legal business name | Fredrickson, Mick |
| Credentials | Licensed Clinical Social Worker (LCSW) |
| Entity | Individual |
| Sole proprietor 1 | Yes |
| Enumeration date | Jun 29th, 2012 |
| Last updated | Apr 14th, 2021 - about 5 years ago |
1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.
Identifiers
| State | Type | Number | Issuer |
|---|---|---|---|
| All States | NPI | 1104180520 | NPPES |
| Oregon | MEDICAID | 500710040 |
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