Provider Demographics
NPI:1174634463
Name:BROERS, MARSHA L (MA)
Entity Type:Individual
Prefix:MS
First Name:MARSHA
Middle Name:L
Last Name:BROERS
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:33 E COLORADO AVE
Mailing Address - Street 2:PRAIRIE BUILDING
Mailing Address - City:FRANKFORT
Mailing Address - State:IL
Mailing Address - Zip Code:60423-1385
Mailing Address - Country:US
Mailing Address - Phone:815-685-1225
Mailing Address - Fax:815-464-1289
Practice Address - Street 1:33 E COLORADO AVE
Practice Address - Street 2:PRAIRIE BUILDING
Practice Address - City:FRANKFORT
Practice Address - State:IL
Practice Address - Zip Code:60423-1385
Practice Address - Country:US
Practice Address - Phone:815-685-1225
Practice Address - Fax:815-464-1289
Is Sole Proprietor?:No
Enumeration Date:2006-08-31
Last Update Date:2008-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL180004856101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional