Individual
MARYANNE QUACKENBUSH
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LICSW
Contact information
Practice address
215 N CENTRAL AVE, DULUTH, MN 55807-2402
(218) 624-5683
(218) 624-5736
Mailing address
1401 EAST FIRST STREET, DULUTH, MN 55805
(218) 728-4404
(218) 728-4404
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
04051
MN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
333357400
—
MN
Enumeration date
07/02/2006
Last updated
05/23/2012
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