Provider Demographics
NPI:1346569746
Name:REDMOND, MARK (MSW, LCSW)
Entity Type:Individual
Prefix:MR
First Name:MARK
Middle Name:
Last Name:REDMOND
Suffix:
Gender:M
Credentials:MSW, LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:410 OXFORD ST SE
Mailing Address - Street 2:
Mailing Address - City:SALEM
Mailing Address - State:OR
Mailing Address - Zip Code:97302-5252
Mailing Address - Country:US
Mailing Address - Phone:503-302-6428
Mailing Address - Fax:
Practice Address - Street 1:410 OXFORD ST SE
Practice Address - Street 2:
Practice Address - City:SALEM
Practice Address - State:OR
Practice Address - Zip Code:97302-5252
Practice Address - Country:US
Practice Address - Phone:503-302-6428
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-05-25
Last Update Date:2023-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORL62331041C0700X
NCC0031081041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical