Provider Demographics
NPI:1861505810
Name:CRONICAN-WALKER, MARSHALL B (LMSW)
Entity Type:Individual
Prefix:MR
First Name:MARSHALL
Middle Name:B
Last Name:CRONICAN-WALKER
Suffix:
Gender:M
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:105 HALL ST
Mailing Address - Street 2:
Mailing Address - City:TRAVERSE CITY
Mailing Address - State:MI
Mailing Address - Zip Code:49684-2288
Mailing Address - Country:US
Mailing Address - Phone:231-935-4181
Mailing Address - Fax:231-935-4275
Practice Address - Street 1:105 HALL ST
Practice Address - Street 2:
Practice Address - City:TRAVERSE CITY
Practice Address - State:MI
Practice Address - Zip Code:49684-2288
Practice Address - Country:US
Practice Address - Phone:231-935-4181
Practice Address - Fax:231-935-4275
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-16
Last Update Date:2013-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI68010137311041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MIM19900019Medicare ID - Type Unspecified