Provider Demographics
NPI:1679316327
Name:MARQUETTE, CALEB RODNEY I
Entity type:Individual
Prefix:
First Name:CALEB
Middle Name:RODNEY
Last Name:MARQUETTE
Suffix:I
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9065 LYNDALE AVE S
Mailing Address - Street 2:
Mailing Address - City:BLOOMINGTON
Mailing Address - State:MN
Mailing Address - Zip Code:55420-3502
Mailing Address - Country:US
Mailing Address - Phone:952-395-3326
Mailing Address - Fax:
Practice Address - Street 1:9065 LYNDALE AVE S
Practice Address - Street 2:
Practice Address - City:BLOOMINGTON
Practice Address - State:MN
Practice Address - Zip Code:55420-3502
Practice Address - Country:US
Practice Address - Phone:952-395-3326
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-06-18
Last Update Date:2024-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician