Provider Demographics
NPI:1871038158
Name:LINQUIST, ALICIA M (LISW-S)
Entity Type:Individual
Prefix:
First Name:ALICIA
Middle Name:M
Last Name:LINQUIST
Suffix:
Gender:F
Credentials:LISW-S
Other - Prefix:
Other - First Name:ALICIA
Other - Middle Name:M
Other - Last Name:ROBINSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:3146 ELLIOT AVE
Mailing Address - Street 2:
Mailing Address - City:DAYTON
Mailing Address - State:OH
Mailing Address - Zip Code:45420-1936
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:3146 ELLIOT AVE
Practice Address - Street 2:
Practice Address - City:DAYTON
Practice Address - State:OH
Practice Address - Zip Code:45420-1936
Practice Address - Country:US
Practice Address - Phone:937-342-3922
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-12-22
Last Update Date:2022-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHI.1801279-SUPV1041C0700X
OHI.18012791041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical