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General NPI Number Information
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NPI Number | 1528580396
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Entity Type | Individual
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Provider Name | ERIC LINDQUIST LCSW
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Gender | Male
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Dates
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Enumeration Date | 07/12/2017
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Last Update Date | 07/20/2025
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Provider Practice Location Address
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Address Line | 555 S PERRYVILLE RD STE 124
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City | ROCKFORD
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State | IL
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Zip | 61108-2522
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Country | US
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Telephone | 815-997-2475
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Fax | 844-927-4623
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Provider Business Mailing Address
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Address Line | 731 LUNDVALL AVE
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City | ROCKFORD
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State | IL
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Zip | 61107-3320
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Country | US
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Telephone | 815-997-2475
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Fax | 815-904-6419
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | 149.019543
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License Number State | IL
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