Healthcare Provider Details

I. General information

NPI: 1700860921
Provider Name (Legal Business Name): LINDA L MARSHALL MSW LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 12/01/2005
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

16110 SW REGATTA LN
BEAVERTON OR
97006-8942
US

IV. Provider business mailing address

16110 SW REGATTA LN
BEAVERTON OR
97006-8942
US

V. Phone/Fax

Practice location:
  • Phone: 503-617-0997
  • Fax: 503-617-9379
Mailing address:
  • Phone: 503-617-0997
  • Fax: 503-617-9379

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number630
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: