Healthcare Provider Details

I. General information

NPI: 1740436484
Provider Name (Legal Business Name): JEFFREY DAVID MARQUIS M.A., M.ED
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/13/2008
Last Update Date: 03/30/2026
Certification Date: 03/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15802 N PARKVIEW PL
SURPRISE AZ
85374-7466
US

IV. Provider business mailing address

16772 W WINDERMERE WAY
SURPRISE AZ
85374-6808
US

V. Phone/Fax

Practice location:
  • Phone: 623-876-7000
  • Fax:
Mailing address:
  • Phone: 623-876-7541
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TS0200X
TaxonomySchool Psychologist
License Number3258963
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: