Provider Demographics
NPI:1215362652
Name:ADLESICH, MARSHA JEAN
Entity Type:Individual
Prefix:MRS
First Name:MARSHA
Middle Name:JEAN
Last Name:ADLESICH
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1324
Mailing Address - Street 2:
Mailing Address - City:MCMINNVILLE
Mailing Address - State:OR
Mailing Address - Zip Code:97128-1324
Mailing Address - Country:US
Mailing Address - Phone:503-583-0024
Mailing Address - Fax:
Practice Address - Street 1:14985 NW ORCHARD VIEW RD
Practice Address - Street 2:
Practice Address - City:MCMINNVILLE
Practice Address - State:OR
Practice Address - Zip Code:97128-8083
Practice Address - Country:US
Practice Address - Phone:503-583-0024
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-09-04
Last Update Date:2013-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst