Provider Demographics
NPI:1538204797
Name:MARSHALL, AMY (MS)
Entity type:Individual
Prefix:MRS
First Name:AMY
Middle Name:
Last Name:MARSHALL
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:502 N PEORIA ST
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60622-8231
Mailing Address - Country:US
Mailing Address - Phone:312-545-6210
Mailing Address - Fax:312-455-8202
Practice Address - Street 1:502 N PEORIA ST
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60622-8231
Practice Address - Country:US
Practice Address - Phone:312-545-6210
Practice Address - Fax:312-455-8202
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL146-007325235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist