Healthcare Provider Details

I. General information

NPI: 1891088746
Provider Name (Legal Business Name): JANELLE KISIDAY MARSHALL AU.D,
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/25/2011
Last Update Date: 06/06/2024
Certification Date: 06/06/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

270 PHILADELPHIA ST
INDIANA PA
15701-2052
US

IV. Provider business mailing address

270 PHILADELPHIA ST
INDIANA PA
15701-2052
US

V. Phone/Fax

Practice location:
  • Phone: 724-349-5070
  • Fax: 724-349-8368
Mailing address:
  • Phone: 724-349-5070
  • Fax: 724-349-8368

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code231H00000X
TaxonomyAudiologist
License Number2201001473
License Number StateVA
# 2
Primary TaxonomyN
Taxonomy Code231H00000X
TaxonomyAudiologist
License NumberAT006203
License Number StatePA
# 3
Primary TaxonomyN
Taxonomy Code231HA2400X
TaxonomyAssistive Technology Practitioner Audiologist
License NumberAT006203
License Number StatePA
# 4
Primary TaxonomyN
Taxonomy Code237600000X
TaxonomyAudiologist-Hearing Aid Fitter
License NumberAT006203
License Number StatePA
# 5
Primary TaxonomyN
Taxonomy Code231HA2500X
TaxonomyAssistive Technology Supplier Audiologist
License NumberAT006203
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: