Provider Demographics
NPI:1679261341
Name:MARSHALL, ANNA MARY-LYNN
Entity Type:Individual
Prefix:MS
First Name:ANNA
Middle Name:MARY-LYNN
Last Name:MARSHALL
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 1:67155 S FOREST AVE
Mailing Address - Street 2:
Mailing Address - City:LENOX
Mailing Address - State:MI
Mailing Address - Zip Code:48050-1429
Mailing Address - Country:US
Mailing Address - Phone:586-703-4485
Mailing Address - Fax:
Practice Address - Street 1:67155 S FOREST AVE
Practice Address - Street 2:
Practice Address - City:LENOX
Practice Address - State:MI
Practice Address - Zip Code:48050-1429
Practice Address - Country:US
Practice Address - Phone:586-703-4485
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-05-01
Last Update Date:2023-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst