Provider Demographics
NPI:1689975633
Name:DYGERT, FREDERICK M (LCSW)
Entity type:Individual
Prefix:
First Name:FREDERICK
Middle Name:M
Last Name:DYGERT
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:242 CANARY AVE
Mailing Address - Street 2:
Mailing Address - City:CRESWELL
Mailing Address - State:OR
Mailing Address - Zip Code:97426-9879
Mailing Address - Country:US
Mailing Address - Phone:541-520-1679
Mailing Address - Fax:
Practice Address - Street 1:1711 WILLAMETTE ST STE 2
Practice Address - Street 2:
Practice Address - City:EUGENE
Practice Address - State:OR
Practice Address - Zip Code:97401-4014
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:2025-05-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR97-04-19101YA0400X
ORA2316104100000X
ORL52271041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No104100000XBehavioral Health & Social Service ProvidersSocial Worker