Healthcare Provider Details

I. General information

NPI: 1427299932
Provider Name (Legal Business Name): IVY ROSE MARSH LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/12/2009
Last Update Date: 04/08/2025
Certification Date: 04/08/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

167 N ADAMS ST
EUGENE OR
97402-4203
US

IV. Provider business mailing address

167 N ADAMS ST
EUGENE OR
97402-4203
US

V. Phone/Fax

Practice location:
  • Phone: 512-767-0685
  • Fax:
Mailing address:
  • Phone: 512-767-0685
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number12531458-3501
License Number StateUT
# 2
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberL15930
License Number StateOR
# 3
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number42293
License Number StateTX

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: