Provider Demographics
NPI:1740785856
Name:MARSHALL, KATELYN D (LISW-S)
Entity type:Individual
Prefix:MISS
First Name:KATELYN
Middle Name:D
Last Name:MARSHALL
Suffix:
Gender:F
Credentials:LISW-S
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:506 THE ALAMEDA
Mailing Address - Street 2:
Mailing Address - City:MIDDLETOWN
Mailing Address - State:OH
Mailing Address - Zip Code:45044-4812
Mailing Address - Country:US
Mailing Address - Phone:513-607-7124
Mailing Address - Fax:
Practice Address - Street 1:8904 BROOKSIDE AVE # OH
Practice Address - Street 2:
Practice Address - City:WEST CHESTER
Practice Address - State:OH
Practice Address - Zip Code:45069-3139
Practice Address - Country:US
Practice Address - Phone:513-644-1030
Practice Address - Fax:513-644-1030
Is Sole Proprietor?:No
Enumeration Date:2018-03-29
Last Update Date:2024-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN34010215A1041C0700X
KY2575541041C0700X
OHS13032271041C0700X
OHI.22033621041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical