MEDICARE: JEANETTE MARQUEZ CSW

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1041C0700X	Clinical Social Worker	13970983-3502	UT

General Provider Information

NPI Number	:	1538957923
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JEANETTE MARQUEZ CSW

Provider Business Mailing Address
First Line	:	415 S 200 W
Second Line	:
City	:	OGDEN
State	:	UT
Zip	:	84404-7340
Country	:	US
Telephone Number	:	801-668-8126
Fax Number	:

Provider Business Practice Location Address
First Line	:	2661 WASHINGTON BLVD
Second Line	:
City	:	OGDEN
State	:	UT
Zip	:	84401-8528
Country	:	US
Telephone Number	:	801-621-8670
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/28/2025
Last Update Date	:	04/28/2025

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Directions to “ JEANETTE MARQUEZ CSW” Practice Location

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