Provider Demographics
NPI:1558994558
Name:LUNDQUIST, TASHA IRENE (LMSW)
Entity Type:Individual
Prefix:
First Name:TASHA
Middle Name:IRENE
Last Name:LUNDQUIST
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1475 S LATAH ST
Mailing Address - Street 2:
Mailing Address - City:BOISE
Mailing Address - State:ID
Mailing Address - Zip Code:83705-2920
Mailing Address - Country:US
Mailing Address - Phone:208-600-2502
Mailing Address - Fax:
Practice Address - Street 1:1475 S LATAH ST
Practice Address - Street 2:
Practice Address - City:BOISE
Practice Address - State:ID
Practice Address - Zip Code:83705-2920
Practice Address - Country:US
Practice Address - Phone:208-600-2502
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-02-18
Last Update Date:2020-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ID38444104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker