Provider Demographics
NPI:1700392826
Name:QUIJANO, LOUISE M (MSW, PHD)
Entity Type:Individual
Prefix:DR
First Name:LOUISE
Middle Name:M
Last Name:QUIJANO
Suffix:
Gender:F
Credentials:MSW, PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5864 QUARRY ST
Mailing Address - Street 2:
Mailing Address - City:TIMNATH
Mailing Address - State:CO
Mailing Address - Zip Code:80547-2502
Mailing Address - Country:US
Mailing Address - Phone:281-795-6529
Mailing Address - Fax:
Practice Address - Street 1:14272 COUNTY ROAD 72
Practice Address - Street 2:
Practice Address - City:GREELEY
Practice Address - State:CO
Practice Address - Zip Code:80631-9371
Practice Address - Country:US
Practice Address - Phone:281-795-6529
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-12-27
Last Update Date:2017-12-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO12111041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical