Provider Demographics
NPI:1932381647
Name:MICHAEL REDIGER LICSW INC
Entity Type:Organization
Organization Name:MICHAEL REDIGER LICSW INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:J
Authorized Official - Last Name:REDIGER
Authorized Official - Suffix:
Authorized Official - Credentials:LICSW
Authorized Official - Phone:206-931-4875
Mailing Address - Street 1:1904 3RD AVE
Mailing Address - Street 2:SUITE 630
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98101-1126
Mailing Address - Country:US
Mailing Address - Phone:206-931-4875
Mailing Address - Fax:206-405-1774
Practice Address - Street 1:1904 3RD AVE
Practice Address - Street 2:SUITE 630
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98101-1126
Practice Address - Country:US
Practice Address - Phone:206-931-4875
Practice Address - Fax:206-405-1774
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-12-04
Last Update Date:2007-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WALW000043981041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty