Provider Demographics
NPI:1427841451
Name:MARQUEZ, INGRID VANESSA (LMT)
Entity type:Individual
Prefix:
First Name:INGRID
Middle Name:VANESSA
Last Name:MARQUEZ
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2532 S SPAULDING AVE
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60623-4047
Mailing Address - Country:US
Mailing Address - Phone:312-779-1179
Mailing Address - Fax:312-779-1179
Practice Address - Street 1:2532 S SPAULDING AVE
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60623-4047
Practice Address - Country:US
Practice Address - Phone:312-779-1179
Practice Address - Fax:312-779-1179
Is Sole Proprietor?:No
Enumeration Date:2025-05-23
Last Update Date:2025-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL227.023918225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist