Provider Demographics
NPI:1306092820
Name:QUICKSALL, LARRY EDWARD (LCSW)
Entity type:Individual
Prefix:
First Name:LARRY
Middle Name:EDWARD
Last Name:QUICKSALL
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1901 S 4TH ST STE 7
Mailing Address - Street 2:
Mailing Address - City:EFFINGHAM
Mailing Address - State:IL
Mailing Address - Zip Code:62401-4162
Mailing Address - Country:US
Mailing Address - Phone:217-347-5937
Mailing Address - Fax:
Practice Address - Street 1:1901 S 4TH ST STE 7
Practice Address - Street 2:
Practice Address - City:EFFINGHAM
Practice Address - State:IL
Practice Address - Zip Code:62401-4162
Practice Address - Country:US
Practice Address - Phone:217-347-5937
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-08-15
Last Update Date:2024-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL145-0055991041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical