Healthcare Provider Details

I. General information

NPI: 1346772431
Provider Name (Legal Business Name): JOANNA MARQUINA M.A.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/29/2017
Last Update Date: 03/29/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10537 S ROBERTS RD
PALOS HILLS IL
60465-1933
US

IV. Provider business mailing address

2946 W BELLE PLAINE AVE APT 2
CHICAGO IL
60618-2624
US

V. Phone/Fax

Practice location:
  • Phone: 708-974-2300
  • Fax: 708-974-2498
Mailing address:
  • Phone: 708-974-2300
  • Fax: 708-974-2498

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: