Healthcare Provider Details

I. General information

NPI: 1467194183
Provider Name (Legal Business Name): PATRICE ANN MARSHALL
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/12/2022
Last Update Date: 04/27/2022
Certification Date: 04/27/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

606 MEDICAL PARKWAY
ENTERPRISE OR
97828
US

IV. Provider business mailing address

606 MEDICAL PARKWAY
ENTERPRISE OR
97828
US

V. Phone/Fax

Practice location:
  • Phone: 541-805-5954
  • Fax:
Mailing address:
  • Phone: 541-805-5954
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103TA0700X
TaxonomyAdult Development & Aging Psychologist
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: