Healthcare Provider Details

I. General information

NPI: 1588369458
Provider Name (Legal Business Name): CRAIG ANDREW MARQUARDT PH.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/31/2023
Last Update Date: 08/15/2026
Certification Date: 08/15/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1041 GRAND AVE UNIT 134
SAINT PAUL MN
55105-3002
US

IV. Provider business mailing address

1041 GRAND AVE UNIT 134
SAINT PAUL MN
55105-3002
US

V. Phone/Fax

Practice location:
  • Phone: 612-629-7350
  • Fax:
Mailing address:
  • Phone: 612-217-1633
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License NumberLP6913
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: