MR. GARY FREDERICKSEN, LICSW

Social Worker - Clinical

Active Individual
NPI: 1700950557

Practice Address

4422 6TH AVE SE
Lacey, WA 98503

Phone: (360) 704-7170

Specialties

Specialty Code Primary License
Counselor - Mental Health 101YM0800X No LW00004165 (WA)
Social Worker - Clinical 1041C0700X Yes LW00004165 (WA)

Frequently Asked Questions

NPI 1700950557 is the National Provider Identifier for MR. GARY FREDERICKSEN, LICSW, a Social Worker - Clinical provider located in Lacey, WA. This NPI was enumerated on November 20, 2006.
MR. GARY FREDERICKSEN, LICSW practices at 4422 6TH AVE SE, Lacey, WA 98503.

Quick Facts

NPI
1700950557
Type
Individual
Enumerated
Nov 20, 2006
Last Updated
Jul 20, 2007

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