Provider Demographics
NPI:1689558876
Name:MARSHALLECK, KAREN ANN
Entity type:Individual
Prefix:
First Name:KAREN
Middle Name:ANN
Last Name:MARSHALLECK
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 20722
Mailing Address - Street 2:
Mailing Address - City:RIVERSIDE
Mailing Address - State:CA
Mailing Address - Zip Code:92516-0722
Mailing Address - Country:US
Mailing Address - Phone:951-662-9847
Mailing Address - Fax:
Practice Address - Street 1:PO BOX 20722
Practice Address - Street 2:
Practice Address - City:RIVERSIDE
Practice Address - State:CA
Practice Address - Zip Code:92516-0722
Practice Address - Country:US
Practice Address - Phone:951-662-9847
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-08-01
Last Update Date:2025-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA393734163W00000X
CALMFT45436106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
No163W00000XNursing Service ProvidersRegistered Nurse