Provider Demographics
NPI:1164021044
Name:FREDERICK DYGERT, LCSW
Entity Type:Organization
Organization Name:FREDERICK DYGERT, LCSW
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:FREDERICK
Authorized Official - Middle Name:
Authorized Official - Last Name:DYGERT
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:541-520-1679
Mailing Address - Street 1:1430 WILLAMETTE ST # 608
Mailing Address - Street 2:
Mailing Address - City:EUGENE
Mailing Address - State:OR
Mailing Address - Zip Code:97401-4049
Mailing Address - Country:US
Mailing Address - Phone:541-520-1679
Mailing Address - Fax:
Practice Address - Street 1:1445 WILLAMETTE ST STE 2B
Practice Address - Street 2:
Practice Address - City:EUGENE
Practice Address - State:OR
Practice Address - Zip Code:97401-4087
Practice Address - Country:US
Practice Address - Phone:541-520-1679
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-10-21
Last Update Date:2020-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty