Provider Demographics
NPI:1760613087
Name:MARQUARDT, VICKI J (PSYD)
Entity Type:Individual
Prefix:MS
First Name:VICKI
Middle Name:J
Last Name:MARQUARDT
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1002 LINCOLN AVE
Mailing Address - Street 2:
Mailing Address - City:BARABOO
Mailing Address - State:WI
Mailing Address - Zip Code:53913-1808
Mailing Address - Country:US
Mailing Address - Phone:608-356-9055
Mailing Address - Fax:608-356-5447
Practice Address - Street 1:1002 LINCOLN AVE
Practice Address - Street 2:
Practice Address - City:BARABOO
Practice Address - State:WI
Practice Address - Zip Code:53913-1808
Practice Address - Country:US
Practice Address - Phone:608-356-9055
Practice Address - Fax:608-356-5447
Is Sole Proprietor?:No
Enumeration Date:2009-08-04
Last Update Date:2009-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI4235125101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health