Provider Demographics
NPI:1942984729
Name:MARTIN, MARCIA GANSEN
Entity Type:Individual
Prefix:
First Name:MARCIA
Middle Name:GANSEN
Last Name:MARTIN
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 1:927 N 2ND ST
Mailing Address - Street 2:
Mailing Address - City:CLINTON
Mailing Address - State:IA
Mailing Address - Zip Code:52732-3750
Mailing Address - Country:US
Mailing Address - Phone:563-513-8728
Mailing Address - Fax:
Practice Address - Street 1:119 S MAIN ST STE 3
Practice Address - Street 2:
Practice Address - City:MAQUOKETA
Practice Address - State:IA
Practice Address - Zip Code:52060-3000
Practice Address - Country:US
Practice Address - Phone:563-513-8728
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-06-13
Last Update Date:2023-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health