1528218427 NPI number — MRS. AMY T MARSHMAN LMSW, LCSW

Table of content: MRS. AMY T MARSHMAN LMSW, LCSW (NPI 1528218427)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1528218427 NPI number — MRS. AMY T MARSHMAN LMSW, LCSW

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
MARSHMAN
Provider First Name:
AMY
Provider Middle Name:
T
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
LMSW, LCSW
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1528218427
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
02/27/2009
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
831 GAME TRL APT 101
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
LAKEMOOR
Provider Business Mailing Address State Name:
IL
Provider Business Mailing Address Postal Code:
60051-6418
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
773-603-5566
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
831 GAME TRL APT 101
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
LAKEMOOR
Provider Business Practice Location Address State Name:
IL
Provider Business Practice Location Address Postal Code:
60051-6418
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
773-603-5566
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
09/26/2008

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 1041C0700X , with the licence number:  149013134 , registered in the state of IL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 1041C0700X , with the licence number: 7416-123 , registered in the state of WI ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 1041C0700X , with the licence number: 6801089300 , registered in the state of MI ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

Other Provider's Identifiers (legacy, non-NPI)