Provider Demographics
NPI:1417624800
Name:MARSHALL, RYAN L (MA)
Entity Type:Individual
Prefix:
First Name:RYAN
Middle Name:L
Last Name:MARSHALL
Suffix:
Gender:M
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16748 LAKE FOREST BLVD
Mailing Address - Street 2:
Mailing Address - City:LAKE OSWEGO
Mailing Address - State:OR
Mailing Address - Zip Code:97035-4144
Mailing Address - Country:US
Mailing Address - Phone:541-521-2409
Mailing Address - Fax:
Practice Address - Street 1:5200 MEADOWS RD STE 200
Practice Address - Street 2:
Practice Address - City:LAKE OSWEGO
Practice Address - State:OR
Practice Address - Zip Code:97035-0086
Practice Address - Country:US
Practice Address - Phone:503-345-3260
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-08-24
Last Update Date:2021-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORR7058101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Multi-Specialty