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General NPI Number Information
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NPI Number | 1174793236
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Entity Type | Individual
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Provider Name | MARSHALL L KIRKPATRICK
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Gender | Male
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Dates
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Enumeration Date | 03/05/2008
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Last Update Date | 09/28/2024
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Provider Practice Location Address
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Address Line | PO BOX 218
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City | REEDSVILLE
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State | WI
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Zip | 54230-0218
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Country | US
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Telephone | 920-840-2745
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Fax |
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Provider Business Mailing Address
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Address Line | 109 N RUBY ST
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City | ELLENSBURG
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State | WA
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Zip | 98926-3382
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Country | US
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Telephone | 509-933-1354
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Fax |
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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 | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | LH00011185
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License Number State | WA
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Taxonomy #2
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number | 6170-125
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License Number State | WI
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