Provider Demographics
NPI:1093176786
Name:MARSHALL, ANNE (LBA)
Entity Type:Individual
Prefix:
First Name:ANNE
Middle Name:
Last Name:MARSHALL
Suffix:
Gender:F
Credentials:LBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:403 BLENHEIM CT
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40207-3400
Mailing Address - Country:US
Mailing Address - Phone:502-428-9146
Mailing Address - Fax:502-365-2241
Practice Address - Street 1:403 BLENHEIM CT
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40207-3400
Practice Address - Country:US
Practice Address - Phone:502-428-9146
Practice Address - Fax:502-365-2241
Is Sole Proprietor?:Yes
Enumeration Date:2016-03-09
Last Update Date:2016-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KYABALBA00225139103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst