Provider Demographics
NPI:1376718130
Name:MARQUEZ, JENNIE N (CRC, LCPC)
Entity Type:Individual
Prefix:MS
First Name:JENNIE
Middle Name:N
Last Name:MARQUEZ
Suffix:
Gender:F
Credentials:CRC, LCPC
Other - Prefix:MS
Other - First Name:JENNIE
Other - Middle Name:N
Other - Last Name:MADURA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:406 N STATE ST
Mailing Address - Street 2:
Mailing Address - City:BELVIDERE
Mailing Address - State:IL
Mailing Address - Zip Code:61008-2740
Mailing Address - Country:US
Mailing Address - Phone:815-977-1425
Mailing Address - Fax:
Practice Address - Street 1:1491 S BELL SCHOOL RD
Practice Address - Street 2:
Practice Address - City:ROCKFORD
Practice Address - State:IL
Practice Address - Zip Code:61108-1407
Practice Address - Country:US
Practice Address - Phone:815-277-9402
Practice Address - Fax:815-277-9412
Is Sole Proprietor?:No
Enumeration Date:2008-04-23
Last Update Date:2011-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL180.006644101YP2500X, 101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health