MEDICARE: LISA ANN MARQUETTE LLMSW

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1041C0700X	Clinical Social Worker	I.1302273	OH
2	1041C0700X	Clinical Social Worker	6802082374	MI

General Provider Information

NPI Number	:	1558591974
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LISA ANN MARQUETTE LLMSW

Provider Business Mailing Address
First Line	:	PO BOX 346
Second Line	:
City	:	TOLEDO
State	:	OH
Zip	:	43697-0346
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	7140 PORT SYLVANIA DR
Second Line	:
City	:	TOLEDO
State	:	OH
Zip	:	43617-1176
Country	:	US
Telephone Number	:	567-408-7242
Fax Number	:	517-263-6090

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/20/2009
Last Update Date	:	01/19/2022

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