Provider Demographics
NPI:1316255649
Name:RUNQUIST, ANGELA M (MSW, PLMHP)
Entity type:Individual
Prefix:
First Name:ANGELA
Middle Name:M
Last Name:RUNQUIST
Suffix:
Gender:F
Credentials:MSW, PLMHP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4010 R AVE
Mailing Address - Street 2:APT A-7
Mailing Address - City:KEARNEY
Mailing Address - State:NE
Mailing Address - Zip Code:68847-2302
Mailing Address - Country:US
Mailing Address - Phone:402-910-1063
Mailing Address - Fax:
Practice Address - Street 1:914 BAUMANN DR
Practice Address - Street 2:
Practice Address - City:GRAND ISLAND
Practice Address - State:NE
Practice Address - Zip Code:68803-4401
Practice Address - Country:US
Practice Address - Phone:308-385-5250
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-09-21
Last Update Date:2010-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE9060101YM0800X
NE66991041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical