Provider Demographics
NPI:1386802510
Name:NEWQUIST, LISA SUZANNE (DT)
Entity type:Individual
Prefix:
First Name:LISA
Middle Name:SUZANNE
Last Name:NEWQUIST
Suffix:
Gender:F
Credentials:DT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:421 E WASHINGTON ST
Mailing Address - Street 2:
Mailing Address - City:AUBURN
Mailing Address - State:IL
Mailing Address - Zip Code:62615-9321
Mailing Address - Country:US
Mailing Address - Phone:217-502-2908
Mailing Address - Fax:
Practice Address - Street 1:421 E WASHINGTON ST
Practice Address - Street 2:
Practice Address - City:AUBURN
Practice Address - State:IL
Practice Address - Zip Code:62615-9321
Practice Address - Country:US
Practice Address - Phone:217-502-2908
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-05-23
Last Update Date:2008-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL222Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes222Q00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersDevelopmental Therapist