Provider Demographics
NPI:1366520876
Name:MARQUARDT, JUDITH A (MS ED, ATR-BC)
Entity type:Individual
Prefix:MS
First Name:JUDITH
Middle Name:A
Last Name:MARQUARDT
Suffix:
Gender:F
Credentials:MS ED, ATR-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4310 W CRYSTAL LAKE RD
Mailing Address - Street 2:SUITE I
Mailing Address - City:MCHENRY
Mailing Address - State:IL
Mailing Address - Zip Code:60050-4214
Mailing Address - Country:US
Mailing Address - Phone:815-344-0395
Mailing Address - Fax:815-344-0395
Practice Address - Street 1:4310 W CRYSTAL LAKE RD
Practice Address - Street 2:SUITE I
Practice Address - City:MCHENRY
Practice Address - State:IL
Practice Address - Zip Code:60050-4214
Practice Address - Country:US
Practice Address - Phone:815-344-0395
Practice Address - Fax:815-344-0395
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL180 -001780101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional