Provider Demographics
NPI:1518175884
Name:MARQUARDT, BRENT DUANE (MS, CCC-SLP)
Entity Type:Individual
Prefix:MR
First Name:BRENT
Middle Name:DUANE
Last Name:MARQUARDT
Suffix:
Gender:M
Credentials:MS, CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5976 W MONTEVISTA DR
Mailing Address - Street 2:
Mailing Address - City:FORT GRATIOT
Mailing Address - State:MI
Mailing Address - Zip Code:48059-2703
Mailing Address - Country:US
Mailing Address - Phone:810-385-8310
Mailing Address - Fax:810-385-8310
Practice Address - Street 1:5976 W MONTEVISTA DR
Practice Address - Street 2:
Practice Address - City:FORT GRATIOT
Practice Address - State:MI
Practice Address - Zip Code:48059-2703
Practice Address - Country:US
Practice Address - Phone:810-385-8310
Practice Address - Fax:810-385-8310
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI12032986235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist