Provider Demographics
NPI:1689975633
Name:DYGERT, FREDERICK M (CADC III, ACSW)
Entity Type:Individual
Prefix:
First Name:FREDERICK
Middle Name:M
Last Name:DYGERT
Suffix:
Gender:M
Credentials:CADC III, ACSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3525 FERRY ST
Mailing Address - Street 2:
Mailing Address - City:EUGENE
Mailing Address - State:OR
Mailing Address - Zip Code:97405-3854
Mailing Address - Country:US
Mailing Address - Phone:541-520-1679
Mailing Address - Fax:
Practice Address - Street 1:3525 FERRY ST
Practice Address - Street 2:
Practice Address - City:EUGENE
Practice Address - State:OR
Practice Address - Zip Code:97405-3854
Practice Address - Country:US
Practice Address - Phone:541-520-1679
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-11-08
Last Update Date:2010-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR97-04-19101YA0400X
ORA2316104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No104100000XBehavioral Health & Social Service ProvidersSocial Worker