Provider Demographics
NPI:1144238262
Name:MARQUARDT, WENDY (PHD)
Entity Type:Individual
Prefix:DR
First Name:WENDY
Middle Name:
Last Name:MARQUARDT
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:DR
Other - First Name:WENDY
Other - Middle Name:A MCGOWAN
Other - Last Name:MARQUARDT
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PHD
Mailing Address - Street 1:PO BOX 690
Mailing Address - Street 2:
Mailing Address - City:WILTON
Mailing Address - State:CA
Mailing Address - Zip Code:95693-0690
Mailing Address - Country:US
Mailing Address - Phone:916-502-4063
Mailing Address - Fax:916-687-6265
Practice Address - Street 1:6 MEDICAL PLAZA DR
Practice Address - Street 2:
Practice Address - City:ROSEVILLE
Practice Address - State:CA
Practice Address - Zip Code:95661-3037
Practice Address - Country:US
Practice Address - Phone:916-502-4063
Practice Address - Fax:916-687-6265
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-04
Last Update Date:2013-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY20580103G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103G00000XBehavioral Health & Social Service ProvidersClinical Neuropsychologist