CHANNING GREDVIG — Medicare Enrolled Provider (PRACTITIONER - CLINICAL SOCIAL WORKER, CA)
CHANNING GREDVIG — Medicare Enrolled Provider (PRACTITIONER - CLINICAL SOCIAL WORKER, CA) is one of 9,000 enrolled providers in the MedicareEnroll dataset. Key details — Name: CHANNING GREDVIG; Type: Individual; NPI: 1003113622.
| Name | CHANNING GREDVIG |
|---|---|
| Type | Individual |
| NPI | 1003113622 |
| Provider type | PRACTITIONER - CLINICAL SOCIAL WORKER |
| State | CA |
| Enrollment ID | I20150825005695 |
| Multiple NPI flag | N |
| Source | CMS Medicare FFS Public Provider Enrollment (PECOS) |
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