Provider Demographics
NPI:1154742039
Name:LACQUEMENT, ROBIN
Entity type:Individual
Prefix:
First Name:ROBIN
Middle Name:
Last Name:LACQUEMENT
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2908 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:CHURCHVILLE
Mailing Address - State:IA
Mailing Address - Zip Code:50211-9338
Mailing Address - Country:US
Mailing Address - Phone:515-669-9965
Mailing Address - Fax:
Practice Address - Street 1:1409 CLARK ST
Practice Address - Street 2:
Practice Address - City:DES MOINES
Practice Address - State:IA
Practice Address - Zip Code:50314-1964
Practice Address - Country:US
Practice Address - Phone:515-643-6518
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-12-19
Last Update Date:2013-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor