Provider Demographics
NPI:1720631864
Name:MARSHALL-ALLEN, WINTER JOY (RBT-19-92324)
Entity Type:Individual
Prefix:MRS
First Name:WINTER
Middle Name:JOY
Last Name:MARSHALL-ALLEN
Suffix:
Gender:F
Credentials:RBT-19-92324
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3773 FOREST GLEN DR
Mailing Address - Street 2:
Mailing Address - City:HOMER
Mailing Address - State:AK
Mailing Address - Zip Code:99603-7467
Mailing Address - Country:US
Mailing Address - Phone:918-869-9892
Mailing Address - Fax:
Practice Address - Street 1:338800 COMMUNITY COLLEGE DRIVE
Practice Address - Street 2:SUITE 1
Practice Address - City:SOLDOTNA
Practice Address - State:AK
Practice Address - Zip Code:33669
Practice Address - Country:US
Practice Address - Phone:907-262-0893
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-07-18
Last Update Date:2019-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK19-92324106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician