Healthcare Provider Details

I. General information

NPI: 1174793236
Provider Name (Legal Business Name): MARSHALL L KIRKPATRICK
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/05/2008
Last Update Date: 09/28/2024
Certification Date: 09/28/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

PO BOX 218
REEDSVILLE WI
54230-0218
US

IV. Provider business mailing address

109 N RUBY ST
ELLENSBURG WA
98926-3382
US

V. Phone/Fax

Practice location:
  • Phone: 920-840-2745
  • Fax:
Mailing address:
  • Phone: 509-933-1354
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberLH00011185
License Number StateWA
# 2
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number6170-125
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: