Provider Demographics
NPI:1104847052
Name:MARQUART, LINDA MAE (LSW)
Entity Type:Individual
Prefix:MRS
First Name:LINDA
Middle Name:MAE
Last Name:MARQUART
Suffix:
Gender:F
Credentials:LSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1122 3RD ST S
Mailing Address - Street 2:
Mailing Address - City:MOORHEAD
Mailing Address - State:MN
Mailing Address - Zip Code:56560-4016
Mailing Address - Country:US
Mailing Address - Phone:218-236-9534
Mailing Address - Fax:701-237-2625
Practice Address - Street 1:1122 3RD ST S
Practice Address - Street 2:
Practice Address - City:MOORHEAD
Practice Address - State:MN
Practice Address - Zip Code:56560-4016
Practice Address - Country:US
Practice Address - Phone:218-236-9534
Practice Address - Fax:701-237-2625
Is Sole Proprietor?:No
Enumeration Date:2006-07-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ND2160104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker