Provider Demographics
NPI:1760930218
Name:YOUNGQUIST, EMMA KATHERINE
Entity Type:Individual
Prefix:
First Name:EMMA
Middle Name:KATHERINE
Last Name:YOUNGQUIST
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:EMMA
Other - Middle Name:KATHERINE
Other - Last Name:KRIVE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:600 DAKOTA ST STE B
Mailing Address - Street 2:
Mailing Address - City:CRYSTAL LAKE
Mailing Address - State:IL
Mailing Address - Zip Code:60012-3742
Mailing Address - Country:US
Mailing Address - Phone:019-205-9395
Mailing Address - Fax:
Practice Address - Street 1:3251 COMMERCE DR STE C
Practice Address - Street 2:
Practice Address - City:DEKALB
Practice Address - State:IL
Practice Address - Zip Code:60115-7908
Practice Address - Country:US
Practice Address - Phone:901-205-9395
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-09-13
Last Update Date:2024-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI68011014821041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical