Provider Demographics
NPI:1831698547
Name:COLINDRES, MARJORIE
Entity type:Individual
Prefix:MS
First Name:MARJORIE
Middle Name:
Last Name:COLINDRES
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 1:9S070 LAKE DR
Mailing Address - Street 2:
Mailing Address - City:WILLOWBROOK
Mailing Address - State:IL
Mailing Address - Zip Code:60527-2560
Mailing Address - Country:US
Mailing Address - Phone:630-689-3567
Mailing Address - Fax:
Practice Address - Street 1:550 E BOUGHTON RD STE 265
Practice Address - Street 2:
Practice Address - City:BOLINGBROOK
Practice Address - State:IL
Practice Address - Zip Code:60440-2396
Practice Address - Country:US
Practice Address - Phone:331-318-8181
Practice Address - Fax:630-863-7293
Is Sole Proprietor?:Yes
Enumeration Date:2018-02-08
Last Update Date:2021-01-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL149.0180251041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical