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General NPI Number Information
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NPI Number | 1033583851
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Entity Type | Organization
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Legal Business Name | ROBERT K MARSHALL, LLC
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Dates
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Enumeration Date | 11/17/2015
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Last Update Date | 11/17/2015
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Provider Practice Location Address
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Address Line | 9631 W 153RD ST STE 38
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City | ORLAND PARK
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State | IL
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Zip | 60462-3778
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Country | US
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Telephone | 847-533-3806
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Fax |
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Provider Business Mailing Address
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Address Line | 521 CLINTON AVE
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City | OAK PARK
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State | IL
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Zip | 60304-1110
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Country | US
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Telephone | 847-533-3806
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | DR. ROBERT K MARSHALL
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Credential | PH.D.
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Telephone | 847-533-3806
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM0850X
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Taxonomy Name | Adult Mental Health Clinic/Center
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License Number | 71-2524
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License Number State | IL
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