Provider Demographics
NPI:1548669021
Name:MARQUARDT, LYNNE CHRISTINE (IADC)
Entity type:Individual
Prefix:MRS
First Name:LYNNE
Middle Name:CHRISTINE
Last Name:MARQUARDT
Suffix:
Gender:F
Credentials:IADC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:111 EASY ST
Mailing Address - Street 2:
Mailing Address - City:NEW LONDON
Mailing Address - State:IA
Mailing Address - Zip Code:52645-1615
Mailing Address - Country:US
Mailing Address - Phone:319-572-3389
Mailing Address - Fax:
Practice Address - Street 1:304 HIGHWAY 61 N
Practice Address - Street 2:
Practice Address - City:WAPELLO
Practice Address - State:IA
Practice Address - Zip Code:52653-1243
Practice Address - Country:US
Practice Address - Phone:319-523-8436
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-08-20
Last Update Date:2014-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA14029101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)