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General NPI Number Information
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NPI Number | 1427473826
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Entity Type | Organization
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Legal Business Name | DANIEL MARQUARDSEN THERAPY L.L.C
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Dates
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Enumeration Date | 02/22/2014
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Last Update Date | 02/22/2014
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Provider Practice Location Address
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Address Line | 25282 HAZELWOOD DR
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City | NISSWA
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State | MN
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Zip | 56468-2797
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Country | US
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Telephone | 218-670-0205
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Fax |
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Provider Business Mailing Address
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Address Line | 18083 490TH ST
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City | MCGREGOR
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State | MN
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Zip | 55760-4514
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Country | US
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Telephone | 218-670-0205
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Fax |
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Authorized Official
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Title or Position | PSYCHOLOGIST
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Name | DANIEL W MARQUARDSEN
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Credential | LP
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Telephone | 218-670-0205
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251S00000X
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Taxonomy Name | Community/Behavioral Health Agency
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License Number | 4659
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License Number State | MN
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