=====================================================
General NPI Number Information
=====================================================
NPI Number | 1154292878
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | LIVE BIG & LOUD LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 09/16/2025
-----------------------------------------------------
Last Update Date | 09/24/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 3915 PINE GROVE AVE
-----------------------------------------------------
City | FORT GRATIOT
-----------------------------------------------------
State | MI
-----------------------------------------------------
Zip | 48059-4251
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 810-531-8794
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 3915 PINE GROVE AVE
-----------------------------------------------------
City | FORT GRATIOT
-----------------------------------------------------
State | MI
-----------------------------------------------------
Zip | 48059-4251
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 810-531-8794
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER/OPERATOR
-----------------------------------------------------
Name | BRENT DUANE MARQUARDT
-----------------------------------------------------
Credential | MS, CCC-SLP
-----------------------------------------------------
Telephone | 810-531-8794
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 225400000X
-----------------------------------------------------
Taxonomy Name | Rehabilitation Practitioner
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------