Robert J Lagerquist, CHEMICAL DEPENDENCY

Primary specialty

Addiction (Substance Use Disorder) CounselorTaxonomy code 101YA0400X

License

CP00004415 Issued in WA

Practice address

1505 Kla-Ook-Wa Street
Taholah, WA 98587-0219

Phone

(360) 276-4405

Fax

(360) 276-4474

NPI assigned

Dec 18, 2008

Last updated

Dec 18, 2008By the provider in NPPES

Sex

Male

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1229558400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1229558400000",
    "number": "1699911875",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 219",
            "city": "TAHOLAH",
            "state": "WA",
            "postal_code": "985870219",
            "telephone_number": "360-276-4405",
            "fax_number": "360-276-4474"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1505 KLA-OOK-WA STREET",
            "city": "TAHOLAH",
            "state": "WA",
            "postal_code": "985870219",
            "telephone_number": "360-276-4405",
            "fax_number": "360-276-4474"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "LAGERQUIST",
        "first_name": "ROBERT",
        "middle_name": "J",
        "name_prefix": "Mr.",
        "credential": "CHEMICAL DEPENDENCY",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2008-12-18",
        "last_updated": "2008-12-18",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YA0400X",
            "taxonomy_group": "",
            "desc": "Counselor, Addiction (Substance Use Disorder)",
            "state": "WA",
            "license": "CP00004415",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1992817",
            "state": "WA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Mary Louise Hart, ARNP
• Erica Susanna Jackson, SUDP/T
• Mishelle Jackson, SUDPT
• Michelle Elizabeth Kloppman, PHARMACIST
• Gregory G Kozlowski, DDS
• Kimberly Claire McLaury, R.D.
• Pavel Mitin, PHARMD
• Holly Anne Mullins, MASSAGE PRACTITIONER
• Claudia Lee Peterson
• Quinault Chemical Depedency

• Addiction (Substance Use Disorder) Counselor in Taholah, WA
• Providers in Taholah, WA by specialty
• Addiction (Substance Use Disorder) Counselor in Washington

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 18, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.