Healthcare Provider Details

I. General information

NPI: 1033223979
Provider Name (Legal Business Name): JILL ANN MARSHALL LIC, MS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/18/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3235 N 3RD ST
HARRISBURG PA
17110-1308
US

IV. Provider business mailing address

4 SANDY CT
ENOLA PA
17025-1530
US

V. Phone/Fax

Practice location:
  • Phone: 717-234-3839
  • Fax: 717-234-6247
Mailing address:
  • Phone: 717-732-4317
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number006888-L
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: