Provider Demographics
NPI:1528580396
Name:LINDQUIST, ERIC (LCSW)
Entity Type:Individual
Prefix:
First Name:ERIC
Middle Name:
Last Name:LINDQUIST
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:731 LUNDVALL AVE
Mailing Address - Street 2:
Mailing Address - City:ROCKFORD
Mailing Address - State:IL
Mailing Address - Zip Code:61107-3320
Mailing Address - Country:US
Mailing Address - Phone:815-997-2475
Mailing Address - Fax:815-904-6419
Practice Address - Street 1:6735 VISTAGREEN WAY STE 210
Practice Address - Street 2:
Practice Address - City:ROCKFORD
Practice Address - State:IL
Practice Address - Zip Code:61107-5654
Practice Address - Country:US
Practice Address - Phone:815-997-2475
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-07-12
Last Update Date:2023-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL149.0195431041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical