Provider Demographics
NPI:1154546430
Name:REDIGER, MICHAEL (MSW)
Entity type:Individual
Prefix:
First Name:MICHAEL
Middle Name:
Last Name:REDIGER
Suffix:
Gender:M
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2600 W HOWE ST
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98199-4321
Mailing Address - Country:US
Mailing Address - Phone:206-931-4875
Mailing Address - Fax:
Practice Address - Street 1:1904 3RD AVE STE 630
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98101-3316
Practice Address - Country:US
Practice Address - Phone:206-931-4875
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-04-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WALW000043981041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical