Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 101Y00000X | Counselor | ||
Y | 101YP2500X | Professional Counselor | 4352-125 | WI |
NPI | 1003035312 |
---|---|
Provider Name | Maureen T Marshall |
First Address | Madison, WI 53719-1029 |
Second Address | Madison, WI 53719-1029 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 25/04/2007 |
Last Update Date | 04/08/2010 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
1003035312 | (05) | WI |