Provider Demographics
NPI:1164653101
Name:LUNDQUIST, LAURA ELIZABETH (LCSW)
Entity Type:Individual
Prefix:
First Name:LAURA
Middle Name:ELIZABETH
Last Name:LUNDQUIST
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3444 W 4400 S
Mailing Address - Street 2:
Mailing Address - City:WEST VALLEY CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84119-5644
Mailing Address - Country:US
Mailing Address - Phone:385-646-4842
Mailing Address - Fax:385-646-4843
Practice Address - Street 1:3444 W 4400 S
Practice Address - Street 2:
Practice Address - City:WEST VALLEY CITY
Practice Address - State:UT
Practice Address - Zip Code:84119-5644
Practice Address - Country:US
Practice Address - Phone:385-646-4842
Practice Address - Fax:385-646-4843
Is Sole Proprietor?:No
Enumeration Date:2009-08-06
Last Update Date:2010-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT7106614-35011041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical