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General NPI Number Information
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NPI Number | 1154421295
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Entity Type | Individual
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Provider Name | ANGELA R MARSHALL PSYD
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Gender | Female
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Dates
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Enumeration Date | 09/25/2006
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 901 S ROGERS ST SUITE 205
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City | BLOOMINGTON
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State | IN
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Zip | 47403-4756
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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 2164
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City | BLOOMINGTON
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State | IN
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Zip | 47402-2164
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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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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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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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