Mick Fredrickson, LCSW

Primary specialty

Clinical Social WorkerTaxonomy code 1041C0700X

License

L6743 Issued in OR

Practice address

425 2ND Ave SW Ste 102
Albany, OR 97321-2483

Phone

(541) 286-3209

Fax

(541) 704-0040

NPI assigned

Jun 29, 2012

Sex

Male

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in OR

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: No
• Power mobility devices: No
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Specialty

Clinical Social Worker

Education

Other, 2005

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Reclaim Life LLCGroup PAC ID 7416293493, 7 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Reclaim Life, LLC

  • Clinical Social Worker
  • Albany, OR
  • NPI 1043788896
  Medicare reassignment Care Compare group NPD

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1340928000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1618358400000",
    "number": "1104180520",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "425 2ND AVE SW STE 102",
            "city": "ALBANY",
            "state": "OR",
            "postal_code": "973212483",
            "telephone_number": "541-286-3209",
            "fax_number": "541-704-0040"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "425 2ND AVE SW STE 102",
            "city": "ALBANY",
            "state": "OR",
            "postal_code": "973212483",
            "telephone_number": "541-286-3209",
            "fax_number": "541-704-0040"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "425 2nd Ave SW Ste 101D",
            "address_purpose": "LOCATION",
            "city": "Albany",
            "state": "OR",
            "postal_code": "973212483",
            "country_code": "US",
            "telephone_number": "541-220-8223",
            "fax_number": "541-833-0419",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "FREDRICKSON",
        "first_name": "MICK",
        "credential": "LCSW",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2012-06-29",
        "last_updated": "2021-04-14",
        "certification_date": "2021-04-14",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "OR",
            "license": "L6743",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "500710040",
            "state": "OR"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Seth Andrew Fortier, D.C.
• Werner J Fourie
• Cathy Lynn Frazier, ARNP
• Fred Meyer Stores Inc
• Kate Fredrickson, M.S. SLP-C.FY
• Joshua C Freitag
• Amy French, RN
• Jennifer J French, RNFA
• Benjamin Alexander Friedman, OD
• Leta Ann Friedt, R.N.

• Clinical Social Worker in Albany, OR
• Providers in Albany, OR by specialty
• Clinical Social Worker in Oregon

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 14, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.