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General NPI Number Information
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NPI Number | 1659179216
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Entity Type | Individual
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Provider Name | MCKINZIE DANIELLE DUESENBERG-MARSHALL PHD
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Gender | Female
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Dates
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Enumeration Date | 03/07/2025
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Last Update Date | 02/12/2026
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Provider Practice Location Address
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Address Line | 3930 S OLD HIGHWAY 94 STE 102
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City | SAINT CHARLES
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State | MO
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Zip | 63304-2836
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Country | US
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Telephone | 314-960-4545
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Fax |
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Provider Business Mailing Address
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Address Line | 276 ALEXANDRIA DR
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City | SAINT CHARLES
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State | MO
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Zip | 63304-1014
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Country | US
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Telephone | 314-960-4545
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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 | 103T00000X
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Taxonomy Name | Psychologist
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License Number | 2025021316
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License Number State | MO
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Taxonomy #2
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Taxonomy Code | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number | 071011421
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License Number State | IL
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