Provider Demographics
NPI:1992516611
Name:LILJENQUIST, CRESSY ROSE (ADC-T)
Entity type:Individual
Prefix:
First Name:CRESSY
Middle Name:ROSE
Last Name:LILJENQUIST
Suffix:
Gender:F
Credentials:ADC-T
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1401 8TH ST S STE 3
Mailing Address - Street 2:
Mailing Address - City:MOORHEAD
Mailing Address - State:MN
Mailing Address - Zip Code:56560-3658
Mailing Address - Country:US
Mailing Address - Phone:218-284-1800
Mailing Address - Fax:
Practice Address - Street 1:1401 8TH ST S STE 3
Practice Address - Street 2:
Practice Address - City:MOORHEAD
Practice Address - State:MN
Practice Address - Zip Code:56560-3658
Practice Address - Country:US
Practice Address - Phone:218-284-1800
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-01-14
Last Update Date:2025-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN3081101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)