Provider Demographics
NPI:1174793236
Name:KIRKPATRICK, MARSHALL L
Entity type:Individual
Prefix:
First Name:MARSHALL
Middle Name:L
Last Name:KIRKPATRICK
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:109 N RUBY ST
Mailing Address - Street 2:
Mailing Address - City:ELLENSBURG
Mailing Address - State:WA
Mailing Address - Zip Code:98926-3382
Mailing Address - Country:US
Mailing Address - Phone:509-933-1354
Mailing Address - Fax:
Practice Address - Street 1:PO BOX 218
Practice Address - Street 2:
Practice Address - City:REEDSVILLE
Practice Address - State:WI
Practice Address - Zip Code:54230-0218
Practice Address - Country:US
Practice Address - Phone:920-840-2745
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-03-05
Last Update Date:2024-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WALH000111851041C0700X
WI6170-125101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical