Provider Demographics
NPI:1659836278
Name:LUNDQUIST, BROOKE (PHD)
Entity Type:Individual
Prefix:
First Name:BROOKE
Middle Name:
Last Name:LUNDQUIST
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11014 33RD ST SE
Mailing Address - Street 2:
Mailing Address - City:LAKE STEVENS
Mailing Address - State:WA
Mailing Address - Zip Code:98258-5171
Mailing Address - Country:US
Mailing Address - Phone:425-327-2859
Mailing Address - Fax:
Practice Address - Street 1:16705 NE 79TH ST
Practice Address - Street 2:
Practice Address - City:REDMOND
Practice Address - State:WA
Practice Address - Zip Code:98052-4425
Practice Address - Country:US
Practice Address - Phone:425-822-3252
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-02-07
Last Update Date:2019-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMC60419570101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health