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General NPI Number Information
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NPI Number | 1376718130
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Entity Type | Individual
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Provider Name | JENNIE N MARQUEZ CRC, LCPC
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Gender | Female
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Dates
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Enumeration Date | 04/23/2008
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Last Update Date | 04/04/2011
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Provider Practice Location Address
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Address Line | 1491 S BELL SCHOOL RD
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City | ROCKFORD
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State | IL
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Zip | 61108-1407
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Country | US
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Telephone | 815-277-9402
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Fax | 815-277-9412
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Provider Business Mailing Address
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Address Line | 406 N STATE ST
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City | BELVIDERE
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State | IL
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Zip | 61008-2740
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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 |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number | 180.006644
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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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