Provider Demographics
NPI:1114684347
Name:MARKS, AUDRA LEIGH (PSYD)
Entity Type:Individual
Prefix:DR
First Name:AUDRA
Middle Name:LEIGH
Last Name:MARKS
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1900 HASSELL RD
Mailing Address - Street 2:
Mailing Address - City:HOFFMAN ESTATES
Mailing Address - State:IL
Mailing Address - Zip Code:60169-6302
Mailing Address - Country:US
Mailing Address - Phone:847-781-4850
Mailing Address - Fax:847-781-4869
Practice Address - Street 1:1900 HASSELL RD
Practice Address - Street 2:HEALTH AND HUMAN SERVICES
Practice Address - City:HOFFMAN ESTATES
Practice Address - State:IL
Practice Address - Zip Code:60169-6302
Practice Address - Country:US
Practice Address - Phone:847-781-4850
Practice Address - Fax:847-781-4869
Is Sole Proprietor?:No
Enumeration Date:2021-11-22
Last Update Date:2021-11-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL071.009113103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILNONEOtherNONE