Healthcare Provider Details

I. General information

NPI: 1861363889
Provider Name (Legal Business Name): WELLNESS WORKS, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/15/2025
Last Update Date: 09/15/2025
Certification Date: 09/14/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3915 PINE GROVE AVE
FORT GRATIOT MI
48059-4251
US

IV. Provider business mailing address

3915 PINE GROVE AVE
FORT GRATIOT MI
48059-4251
US

V. Phone/Fax

Practice location:
  • Phone: 810-531-8794
  • Fax:
Mailing address:
  • Phone: 810-531-8794
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number
License Number State

VIII. Authorized Official

Name: BRENT DUANE MARQUARDT
Title or Position: OWNER/OPERATOR
Credential: MS, CCC-SLP
Phone: 810-531-8794