Provider Demographics
NPI:1922414960
Name:MARSHALL, KESHONDRA
Entity Type:Individual
Prefix:
First Name:KESHONDRA
Middle Name:
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 1:3450 W CHEYENNE AVE STE 500
Mailing Address - Street 2:
Mailing Address - City:NORTH LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89032-8225
Mailing Address - Country:US
Mailing Address - Phone:702-750-4574
Mailing Address - Fax:
Practice Address - Street 1:3450 W CHEYENNE AVE STE 500
Practice Address - Street 2:
Practice Address - City:NORTH LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89032-8225
Practice Address - Country:US
Practice Address - Phone:702-750-4574
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-07-10
Last Update Date:2014-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst