Individual
RANDY K SODERQUIST
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
LCSW
Contact information
Practice address
465 SOUTH MAIN, FREDONIA, AZ 86022
(928) 643-6000
Mailing address
465 SOUTH MAIN, P.O. BOX 710, FREDONIA, AZ 86022
(928) 643-6000
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
131852-3501
UT
1041C0700X
Clinical Social Worker
LCSW-12612
AZ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
131852-3501
STATE LICENSE
UT
01
—
LCSW-12612
STATE
AZ
Enumeration date
02/02/2007
Last updated
10/12/2012
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