Provider Demographics
NPI:1790447472
Name:MARSONETTE, ANNA MARIE
Entity Type:Individual
Prefix:
First Name:ANNA
Middle Name:MARIE
Last Name:MARSONETTE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:KNIGHT
Other - Middle Name:MARIE
Other - Last Name:MARSONETTE
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:CHOSEN NAME
Mailing Address - Street 1:4745 SW LOMBARD AVE APT 403
Mailing Address - Street 2:
Mailing Address - City:BEAVERTON
Mailing Address - State:OR
Mailing Address - Zip Code:97005-2946
Mailing Address - Country:US
Mailing Address - Phone:971-226-5057
Mailing Address - Fax:
Practice Address - Street 1:4745 SW LOMBARD AVE APT 403
Practice Address - Street 2:
Practice Address - City:BEAVERTON
Practice Address - State:OR
Practice Address - Zip Code:97005-2946
Practice Address - Country:US
Practice Address - Phone:971-226-5057
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-10-09
Last Update Date:2021-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health