Provider Demographics
NPI:1508658311
Name:QUISTORFF, MONIQUE DESIREE (LPCC)
Entity type:Individual
Prefix:
First Name:MONIQUE
Middle Name:DESIREE
Last Name:QUISTORFF
Suffix:
Gender:F
Credentials:LPCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8451 E POINT DOUGLAS RD S
Mailing Address - Street 2:
Mailing Address - City:COTTAGE GROVE
Mailing Address - State:MN
Mailing Address - Zip Code:55016-3331
Mailing Address - Country:US
Mailing Address - Phone:651-255-8590
Mailing Address - Fax:651-458-5632
Practice Address - Street 1:8451 E POINT DOUGLAS RD S
Practice Address - Street 2:
Practice Address - City:COTTAGE GROVE
Practice Address - State:MN
Practice Address - Zip Code:55016-3331
Practice Address - Country:US
Practice Address - Phone:651-255-8590
Practice Address - Fax:651-458-5632
Is Sole Proprietor?:No
Enumeration Date:2025-05-19
Last Update Date:2025-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNCC04851101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health