Provider Demographics
NPI:1659179216
Name:DUESENBERG-MARSHALL, MCKINZIE DANIELLE (PHD)
Entity type:Individual
Prefix:DR
First Name:MCKINZIE
Middle Name:DANIELLE
Last Name:DUESENBERG-MARSHALL
Suffix:
Gender:
Credentials:PHD
Other - Prefix:DR
Other - First Name:MCKINZIE
Other - Middle Name:DANIELLE
Other - Last Name:DUESENBERG
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PHD
Mailing Address - Street 1:276 ALEXANDRIA DR
Mailing Address - Street 2:
Mailing Address - City:SAINT CHARLES
Mailing Address - State:MO
Mailing Address - Zip Code:63304-1014
Mailing Address - Country:US
Mailing Address - Phone:314-960-4545
Mailing Address - Fax:
Practice Address - Street 1:276 ALEXANDRIA DR
Practice Address - Street 2:
Practice Address - City:SAINT CHARLES
Practice Address - State:MO
Practice Address - Zip Code:63304-1014
Practice Address - Country:US
Practice Address - Phone:314-960-4545
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-03-07
Last Update Date:2025-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL071011421103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical