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General NPI Number Information
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NPI Number | 1023449972
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Entity Type | Organization
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Legal Business Name | JENNIE N. MARQUEZ
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Dates
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Enumeration Date | 12/03/2013
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Last Update Date | 12/03/2013
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Provider Practice Location Address
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Address Line | 4777 E STATE ST SUITE 1
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City | ROCKFORD
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State | IL
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Zip | 61108-2273
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Country | US
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Telephone | 815-977-1425
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Fax |
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Provider Business Mailing Address
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Address Line | 416 E LINCOLN AVE
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City | BELVIDERE
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State | IL
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Zip | 61008-2839
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Country | US
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Telephone | 815-977-1425
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Fax |
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Authorized Official
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Title or Position | CEO
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Name | MRS. JENNIE N. MARQUEZ
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Credential | LCPC
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Telephone | 815-977-1425
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | 149.008535
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License Number State | IL
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Taxonomy #2
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | 180-006644
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License Number State | IL
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