Provider Demographics
NPI:1629751797
Name:MARQUEZ, KRISTINA APRIL (LCSW)
Entity Type:Individual
Prefix:MRS
First Name:KRISTINA
Middle Name:APRIL
Last Name:MARQUEZ
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8494 JAMESPORT DR
Mailing Address - Street 2:
Mailing Address - City:ROCKFORD
Mailing Address - State:IL
Mailing Address - Zip Code:61108-7031
Mailing Address - Country:US
Mailing Address - Phone:815-505-5033
Mailing Address - Fax:
Practice Address - Street 1:8494 JAMESPORT DR
Practice Address - Street 2:
Practice Address - City:ROCKFORD
Practice Address - State:IL
Practice Address - Zip Code:61108-7031
Practice Address - Country:US
Practice Address - Phone:815-505-5033
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-08-07
Last Update Date:2023-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL1490183621041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical