Provider Demographics
NPI:1538957923
Name:MARQUEZ, JEANETTE (CSW)
Entity type:Individual
Prefix:
First Name:JEANETTE
Middle Name:
Last Name:MARQUEZ
Suffix:
Gender:F
Credentials:CSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:415 S 200 W
Mailing Address - Street 2:
Mailing Address - City:OGDEN
Mailing Address - State:UT
Mailing Address - Zip Code:84404-7340
Mailing Address - Country:US
Mailing Address - Phone:801-668-8126
Mailing Address - Fax:
Practice Address - Street 1:2661 WASHINGTON BLVD
Practice Address - Street 2:
Practice Address - City:OGDEN
Practice Address - State:UT
Practice Address - Zip Code:84401-8528
Practice Address - Country:US
Practice Address - Phone:801-621-8670
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-04-28
Last Update Date:2025-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT13970983-35021041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical