Provider Demographics
NPI:1124872015
Name:MARSHALL, DESIREE AUDRINA (LSW)
Entity type:Individual
Prefix:
First Name:DESIREE
Middle Name:AUDRINA
Last Name:MARSHALL
Suffix:
Gender:
Credentials:LSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1936 MACH LN
Mailing Address - Street 2:
Mailing Address - City:FRANKLIN
Mailing Address - State:IN
Mailing Address - Zip Code:46131-7025
Mailing Address - Country:US
Mailing Address - Phone:270-970-3115
Mailing Address - Fax:
Practice Address - Street 1:1936 MACH LN
Practice Address - Street 2:
Practice Address - City:FRANKLIN
Practice Address - State:IN
Practice Address - Zip Code:46131-7025
Practice Address - Country:US
Practice Address - Phone:270-970-3115
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-04-16
Last Update Date:2025-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN34011743A1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical