Provider Demographics
NPI:1083021034
Name:MARSHALL, AZIZA (BA, LADC)
Entity Type:Individual
Prefix:
First Name:AZIZA
Middle Name:
Last Name:MARSHALL
Suffix:
Gender:F
Credentials:BA, LADC
Other - Prefix:
Other - First Name:AZIZA
Other - Middle Name:
Other - Last Name:ABDELRAHMAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:800 42ND AVE N
Mailing Address - Street 2:
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55412-1714
Mailing Address - Country:US
Mailing Address - Phone:612-767-6601
Mailing Address - Fax:612-767-6603
Practice Address - Street 1:800 42ND AVE N
Practice Address - Street 2:
Practice Address - City:MINNEAPOLIS
Practice Address - State:MN
Practice Address - Zip Code:55412-1714
Practice Address - Country:US
Practice Address - Phone:612-767-6601
Practice Address - Fax:612-767-6603
Is Sole Proprietor?:No
Enumeration Date:2014-07-22
Last Update Date:2014-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN302773101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)