Provider Demographics
NPI:1528098373
Name:MARSHALL, ROBERT K (PHD)
Entity type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:K
Last Name:MARSHALL
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:521 CLINTON AVE
Mailing Address - Street 2:
Mailing Address - City:OAK PARK
Mailing Address - State:IL
Mailing Address - Zip Code:60304-1110
Mailing Address - Country:US
Mailing Address - Phone:847-533-3806
Mailing Address - Fax:312-777-7747
Practice Address - Street 1:9631 W 153RD ST
Practice Address - Street 2:SUITE 38
Practice Address - City:ORLAND PARK
Practice Address - State:IL
Practice Address - Zip Code:60462-3774
Practice Address - Country:US
Practice Address - Phone:847-533-3806
Practice Address - Fax:312-777-7747
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-04
Last Update Date:2012-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL71-2524103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL796110Medicare ID - Type Unspecified
IL796110Medicare UPIN