Randy K Soderquist, LCSW
Individual provider Active NPI Clinical Social Worker · Fredonia, AZ
NPI 1144368010 · NPPES record last updated Oct 12, 2012
Key facts
- NPI
- 1144368010
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Clinical Social Worker 1041C0700X
- License
- 131852-3501 (UT)
- Practice address
- 465 South Main
Fredonia, AZ 86022 - Phone
- (928) 643-6000
- NPI assigned
- Feb 2, 2007
- Sex
- Male
- Sole proprietor
- No
Organizations & group practices 1
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- Yes
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| LCSW-12612 | AZ | MD | Clinical Social Worker |
| 131852-3501 | UT | MD | Clinical Social Worker |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Southwest Center | Past | Accepting new patients |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Clinical Social Worker | 1041C0700X | 131852-3501 | UT | Yes |
| Clinical Social Worker | 1041C0700X | LCSW-12612 | AZ |
Addresses
Primary practice location
465 South Main
Fredonia, AZ 86022
Mailing address
465 South Main
P.O. Box 710
Fredonia, AZ 86022
Phone (928) 643-6000
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 131852-3501 | Other | UT | STATE LICENSE |
| LCSW-12612 | Other | AZ | STATE |
Other providers in Fredonia, AZ
- Thomas Charles Kinne II
- David Armstrong Lambert
- James Gray Millward
- Re-Creation Retreat LLC
- Andria Soderquist
- Speakn Up LLC
- Catherine P Trudell
- William J Trudell
All providers in Fredonia, AZ · Clinical Social Worker in Arizona
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Oct 12, 2012. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.