Provider Demographics
NPI:1962481010
Name:LUNDQUIST, JON (LCSW)
Entity Type:Individual
Prefix:MR
First Name:JON
Middle Name:
Last Name:LUNDQUIST
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:127 E 2ND ST
Mailing Address - Street 2:SUITE B
Mailing Address - City:RUSSELLVILLE
Mailing Address - State:AR
Mailing Address - Zip Code:72801-5143
Mailing Address - Country:US
Mailing Address - Phone:479-968-3605
Mailing Address - Fax:479-890-3446
Practice Address - Street 1:127 E 2ND ST
Practice Address - Street 2:SUITE B
Practice Address - City:RUSSELLVILLE
Practice Address - State:AR
Practice Address - Zip Code:72801-5143
Practice Address - Country:US
Practice Address - Phone:479-968-3605
Practice Address - Fax:479-890-3446
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-01-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARC-4171041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR5S025Medicare ID - Type Unspecified