Individual
MICK FREDRICKSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
LCSW
Contact information
Practice address
425 2ND AVE SW STE 102, ALBANY, OR 97321-2483
(541) 286-3209
(541) 704-0040
Mailing address
425 2ND AVE SW STE 102, ALBANY, OR 97321-2483
(541) 286-3209
(541) 704-0040
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
L6743
OR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
500710040
—
OR
Enumeration date
06/29/2012
Last updated
04/14/2021
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