Provider Demographics
NPI:1740396241
Name:MARSHALL, DEVONA (LPC)
Entity Type:Individual
Prefix:
First Name:DEVONA
Middle Name:
Last Name:MARSHALL
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:400 W RIVER DR
Mailing Address - Street 2:
Mailing Address - City:WEST BEND
Mailing Address - State:WI
Mailing Address - Zip Code:53090-1518
Mailing Address - Country:US
Mailing Address - Phone:262-334-4340
Mailing Address - Fax:262-334-4341
Practice Address - Street 1:400 W RIVER DR
Practice Address - Street 2:
Practice Address - City:WEST BEND
Practice Address - State:WI
Practice Address - Zip Code:53090-1518
Practice Address - Country:US
Practice Address - Phone:262-334-4340
Practice Address - Fax:262-334-4341
Is Sole Proprietor?:No
Enumeration Date:2006-08-21
Last Update Date:2019-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI3514-125101Y00000X, 101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101Y00000XBehavioral Health & Social Service ProvidersCounselor
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI40984400Medicaid