Healthcare Provider Details

I. General information

NPI: 1457707077
Provider Name (Legal Business Name): SAMUEL STAN PALMQUIST
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/12/2016
Last Update Date: 09/14/2026
Certification Date: 09/14/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1308 E 1ST ST
NEWBERG OR
97132-2941
US

IV. Provider business mailing address

1308 E 1ST ST
NEWBERG OR
97132-2941
US

V. Phone/Fax

Practice location:
  • Phone: 503-383-9212
  • Fax:
Mailing address:
  • Phone: 503-383-9212
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberT1592
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: