Provider Demographics
NPI:1295954196
Name:MARSHALL, ANNETTE KATHLEEN (SLP)
Entity type:Individual
Prefix:
First Name:ANNETTE
Middle Name:KATHLEEN
Last Name:MARSHALL
Suffix:
Gender:F
Credentials:SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7567 MELON CT
Mailing Address - Street 2:
Mailing Address - City:GURNEE
Mailing Address - State:IL
Mailing Address - Zip Code:60031-5618
Mailing Address - Country:US
Mailing Address - Phone:773-454-2157
Mailing Address - Fax:
Practice Address - Street 1:1201 N SHERIDAN RD
Practice Address - Street 2:
Practice Address - City:WAUKEGAN
Practice Address - State:IL
Practice Address - Zip Code:60085-2081
Practice Address - Country:US
Practice Address - Phone:224-303-1000
Practice Address - Fax:224-399-8581
Is Sole Proprietor?:No
Enumeration Date:2007-04-25
Last Update Date:2024-12-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL146008588235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist