Provider Demographics
NPI:1851948483
Name:MARSHALL, MADELEINE (LISW)
Entity Type:Individual
Prefix:
First Name:MADELEINE
Middle Name:
Last Name:MARSHALL
Suffix:
Gender:F
Credentials:LISW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:315 E 5TH ST STE 202
Mailing Address - Street 2:
Mailing Address - City:WATERLOO
Mailing Address - State:IA
Mailing Address - Zip Code:50703-4757
Mailing Address - Country:US
Mailing Address - Phone:319-423-9016
Mailing Address - Fax:319-249-2398
Practice Address - Street 1:2441 CORAL CT STE 3
Practice Address - Street 2:
Practice Address - City:CORALVILLE
Practice Address - State:IA
Practice Address - Zip Code:52241-2872
Practice Address - Country:US
Practice Address - Phone:319-423-9016
Practice Address - Fax:319-249-2398
Is Sole Proprietor?:Yes
Enumeration Date:2019-08-19
Last Update Date:2024-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA0965401041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical