MEDICARE: JEANNE MARSHALL PLLC

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	1041C0700X	Clinical Social Worker

General Provider Information

NPI Number	:	1548049968
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	JEANNE MARSHALL PLLC

Provider Business Mailing Address
First Line	:	110 GREENVILLE AVE
Second Line	:
City	:	WILMINGTON
State	:	NC
Zip	:	28403-3562
Country	:	US
Telephone Number	:	860-710-2507
Fax Number	:	910-251-7859

Provider Business Practice Location Address
First Line	:	720 N 3RD ST STE 101
Second Line	:
City	:	WILMINGTON
State	:	NC
Zip	:	28401-3474
Country	:	US
Telephone Number	:	860-710-2507
Fax Number	:	910-251-7859

Authorized Official
Title or Position	:	OWNER
Name	:	MS. JEANNE MARSHALL
Credential	:	LCSW
Telephone Number	:	860-710-2507

Provider Enumeration Date	:	09/25/2023
Last Update Date	:	09/25/2023

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