Provider Demographics
NPI:1780014845
Name:QUACKENBUSH, EMILY PAGE
Entity Type:Individual
Prefix:MS
First Name:EMILY
Middle Name:PAGE
Last Name:QUACKENBUSH
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3130 LOWELL ST
Mailing Address - Street 2:
Mailing Address - City:EUREKA
Mailing Address - State:CA
Mailing Address - Zip Code:95503-5219
Mailing Address - Country:US
Mailing Address - Phone:530-320-3876
Mailing Address - Fax:
Practice Address - Street 1:3130 LOWELL ST
Practice Address - Street 2:
Practice Address - City:EUREKA
Practice Address - State:CA
Practice Address - Zip Code:95503-5219
Practice Address - Country:US
Practice Address - Phone:530-320-3876
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-11-26
Last Update Date:2013-11-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA171M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator