Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.
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Channing Gredvig, LCSW

Individual provider Clinical Social Worker · NPI 1003113622

Channing Gredvig, LCSW is a Clinical Social Worker in San Diego, California. Qualified in 2003, 23 years ago. Practices with Southern California Permanente Medical Group, an 11,242-clinician group and accepts Medicare assignment. Licensed in California.

Years since qualifying
23
Licensed in
CA
In the registry since
2011
What do these letters mean?
LCSW — Licensed Clinical Social Worker
A social worker licensed to diagnose and treat mental health conditions independently.

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Practice location Address checks out

3420 Kenyon St
San Diego, CA 92110-5001
Phone: (619) 221-6550
Fax: (619) 221-6556
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Pin is approximate — placed at the ZIP-code centre, not the exact door.

Specialties & licences

Clinical Social Worker (primary) Taxonomy 1041C0700X · Licence 64651 (CA)

Record details

NPI number1003113622
Entity typeIndividual (Type 1)
GenderMale
Credentials LCSW
Sole proprietorNo
NPI enumeratedFebruary 16, 2011
Last updated in NPPESNovember 29, 2021

Medicare enrollment

From the CMS Doctors & Clinicians file — this clinician is enrolled in Medicare.

Medicare specialtyCLINICAL SOCIAL WORKER
Medical schoolOTHER
Graduated 2003 (23 years in practice)
Group practice Southern California Permanente Medical Group — 11242 clinicians
Accepts Medicare assignment Yes — accepts the Medicare-approved amount
Practice locations2 on file with Medicare

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