Provider Demographics
NPI:1235338534
Name:MARSHALL, EDWARD OWSLEY (PHD)
Entity Type:Individual
Prefix:DR
First Name:EDWARD
Middle Name:OWSLEY
Last Name:MARSHALL
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:100 VETERANS DR
Mailing Address - Street 2:
Mailing Address - City:WILMORE
Mailing Address - State:KY
Mailing Address - Zip Code:40390-9775
Mailing Address - Country:US
Mailing Address - Phone:859-858-2814
Mailing Address - Fax:
Practice Address - Street 1:100 VETERANS DR
Practice Address - Street 2:
Practice Address - City:WILMORE
Practice Address - State:KY
Practice Address - Zip Code:40390-9775
Practice Address - Country:US
Practice Address - Phone:859-858-2814
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-07-16
Last Update Date:2020-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY129284103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist