MEDICARE: JUDITH IRENE MARSHALL

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	104100000X	Social Worker	6802079661	MI

General Provider Information

NPI Number	:	1518005560
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JUDITH IRENE MARSHALL

Provider Business Mailing Address
First Line	:	38718 BARNSTABLE LN
Second Line	:
City	:	CLINTON TOWNSHIP
State	:	MI
Zip	:	48038-3402
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	21885 DUNHAM RD
Second Line	:
City	:	CLINTON TOWNSHIP
State	:	MI
Zip	:	48036-1030
Country	:	US
Telephone Number	:	586-469-6422
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/02/2007
Last Update Date	:	07/08/2007

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