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Individual
VIAN MAUREEN GREDVIG
Active
Individual
VIAN MAUREEN GREDVIG
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
MSW, LICSW
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
06577
MN
1041C0700X
Clinical Social Worker
6577
MN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1942246806
—
MN
05
—
1942683669
—
MN
05
—
H100234918
—
MN
01
—
H400234929
MEDICARE PTAN
—
Enumeration date
06/21/2006
Last updated
02/04/2023
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