Kathleen A Frederick, LICSW, CACII is a medicare enrolled "Social Worker - Clinical" provider in Portland, Oregon. Her current practice location is
3710 Sw Us Veterans Hospital Road, Portland, Oregon. You can reach out to her office (for appointments etc.) via phone at
(360) 696-4061.
Kathleen A Frederick is licensed to practice in Washington (license number LW 60248502) and she also participates in the medicare program. She does not accept medicare assignments directly but she may accept medicare through third-party (refer to Reassignment section below) and may also prescribe medicare part D drugs. Her NPI Number is 1417257759.
Healthcare Provider's Profile
| Full Name | Kathleen A Frederick |
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| Gender | Female |
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| Speciality | Social Worker - Clinical |
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| Location | 3710 Sw Us Veterans Hospital Road, Portland, Oregon |
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| Accepts Medicare Assignments | Medicare enrolled and may accept medicare through third-party reassignment. May prescribe medicare part D drugs. |
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NPI Data:
- NPI Number: 1417257759
- Provider Enumeration Date: 11/02/2010
- Last Update Date: 08/06/2013
Medicare PECOS Information:
- PECOS PAC ID: 2961871389
- Enrollment ID: I20221207001090
Medical Identifiers
Medical identifiers for Kathleen A Frederick such as npi, medicare ID, medicare PIN, medicaid, etc.
| Identifier | Type | State | Issuer |
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| 1417257759 | NPI | - | NPPES |
Medical Taxonomies and Licenses
| Taxonomy | Type | License (State) | Status |
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| 101YA0400X | Counselor - Addiction (substance Use Disorder) | 6333 (Colorado) | Secondary |
| 1041C0700X | Social Worker - Clinical | 1249 (Colorado) | Secondary |
| 1041C0700X | Social Worker - Clinical | LW 60248502 (Washington) | Primary |
Medicare Reassignments
Some practitioners may not bill the customers directly but medicare billing happens through clinics / group practice / hospitals where the provider works. Medicare reassignment of benefits is a mechanism by which practitioners allow third parties to bill and receive payment for medicare services performed by them. Kathleen A Frederick allows following entities to bill medicare on her behalf.
| Entity Name | Psychological And Life Skills Associates Pc |
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| Entity Type | Part B Supplier - Clinic/group Practice |
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| Entity Identifiers | NPI Number: 1619066727
PECOS PAC ID: 4688661838
Enrollment ID: O20040428001567 |
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Medicare Part D Prescriber Enrollment
Any physician or other eligible professional who prescribes Part D drugs must either enroll in the Medicare program or opt out in order to prescribe drugs to their patients with Part D prescription drug benefit plans. Kathleen A Frederick is
enrolled with medicare and thus, if eligible, can prescribe medicare part D drugs to patients with medicare part D benefits.
Mailing Address and Practice Location
| Mailing Address | Practice Location Address |
|---|
Kathleen A Frederick, LICSW, CACII
3710 Sw Us Veterans Hospital Road, P.o.box 1035,
Portland, OR 97207
Ph: (360) 696-4061 | Kathleen A Frederick, LICSW, CACII
3710 Sw Us Veterans Hospital Road,
Portland, OR 97207
Ph: (360) 696-4061 |
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