Provider Demographics
NPI:1871236653
Name:MARQUARD, MONICA KATHERINE
Entity Type:Individual
Prefix:
First Name:MONICA
Middle Name:KATHERINE
Last Name:MARQUARD
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7430 SW LESLIE ST
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97223-2231
Mailing Address - Country:US
Mailing Address - Phone:503-459-7678
Mailing Address - Fax:
Practice Address - Street 1:6950 SW HAMPTON ST STE 310
Practice Address - Street 2:
Practice Address - City:TIGARD
Practice Address - State:OR
Practice Address - Zip Code:97223-8332
Practice Address - Country:US
Practice Address - Phone:971-238-0096
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-04-19
Last Update Date:2023-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORR8343106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist