Provider Demographics
NPI:1457412025
Name:MARSHACK, KATHY IRENE (PHD)
Entity Type:Individual
Prefix:DR
First Name:KATHY
Middle Name:IRENE
Last Name:MARSHACK
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:MS
Other - First Name:KATHY
Other - Middle Name:IRENE
Other - Last Name:MARIN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:PHD
Mailing Address - Street 1:5930 PACIFIC OVERLOOK DR
Mailing Address - Street 2:
Mailing Address - City:NESKOWIN
Mailing Address - State:OR
Mailing Address - Zip Code:97149-1101
Mailing Address - Country:US
Mailing Address - Phone:503-222-6678
Mailing Address - Fax:360-256-1084
Practice Address - Street 1:5930 PACIFIC OVERLOOK DR
Practice Address - Street 2:
Practice Address - City:NESKOWIN
Practice Address - State:OR
Practice Address - Zip Code:97149-1101
Practice Address - Country:US
Practice Address - Phone:503-222-6678
Practice Address - Fax:360-256-1084
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-13
Last Update Date:2022-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR1192103T00000X
WA1961103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist