Individual
JEAN M FREDRICKSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LCSW
Contact information
Practice address
930 SW ABBEY ST, NEWPORT, OR 97365-4820
(541) 574-1811
Mailing address
930 SW ABBEY ST, NEWPORT, OR 97365-4820
(541) 574-1811
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
L3255
OR
Other
Enumeration date
05/08/2012
Last updated
05/08/2012
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