Provider Demographics
NPI:1831105410
Name:MARQUIS, MIA S (LMFT)
Entity Type:Individual
Prefix:
First Name:MIA
Middle Name:S
Last Name:MARQUIS
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:
Other - First Name:MARIA
Other - Middle Name:T
Other - Last Name:GRUEL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:OT
Mailing Address - Street 1:7974 UW HEALTH CT
Mailing Address - Street 2:
Mailing Address - City:MIDDLETON
Mailing Address - State:WI
Mailing Address - Zip Code:53562-5531
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:2275 DEMING WAY STE 180
Practice Address - Street 2:
Practice Address - City:MIDDLETON
Practice Address - State:WI
Practice Address - Zip Code:53562-5527
Practice Address - Country:US
Practice Address - Phone:608-282-8200
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-01
Last Update Date:2024-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI3374-26225X00000X
WI2144-124106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
No225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI3374-26OtherOT