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General NPI Number Information
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NPI Number | 1033394101
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Entity Type | Organization
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Legal Business Name | ANGELA R MARSHALL PSYD INC
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Dates
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Enumeration Date | 01/08/2008
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Last Update Date | 02/04/2009
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Provider Practice Location Address
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Address Line | 2525 W VERNAL PIKE
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City | BLOOMINGTON
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State | IN
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Zip | 47404-2782
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Country | US
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Telephone | 812-345-5114
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Fax | 812-339-0369
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Provider Business Mailing Address
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Address Line | PO BOX 96
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City | SMITHVILLE
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State | IN
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Zip | 47458-0096
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Country | US
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Telephone | 812-824-8787
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Fax | 812-824-8825
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Authorized Official
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Title or Position | BILLING MANAGER
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Name | LEE D GODSEY
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Credential |
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Telephone | 812-824-8787
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number | 20041898A
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License Number State | IN
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