| Doctor Name: | RANDY K SODERQUIST |
| NPI Number: | 1144368010 |
| Entity Type Code: | Individual (1) |
| Gender: | M |
| Credentials: | LCSW |
| License Number: | LCSW-12612 |
| Business Practice Address: | 465 South Main Fredonia, AZ - 86022 |
| Business Phone Number: | 9286436000 |
| Business Fax Number: | |
| Mailing Address: | 465 South Main, P.o. Box 710 FREDONIA |
| State: | AZ |
| Postal Code: | 86022 |
| Phone Number: | 9286436000 |
| Fax Number: | |
| NPI Enumeration Date: | 02/02/2007 |
| NPI Last Update Date: | 10/12/2012 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 1041C0700X |
| License Number: | LCSW-12612 |
| Healthcare Provider Taxonomy: (Secondary) | N |
| State: | AZ |
| Taxonomy Type: | Behavioral Health & Social Service Providers |
| Taxonomy Classification: | Social Worker |
| Taxonomy Specialization: | Clinical |
| Taxonomy Definition: | A social worker who holds a master |