Marissa Lee Lodge
Marissa Lee Lodge is a Behavior Technician in Rockford, Illinois. Practices as a sole proprietor. Registered with an NPI since 2017.
- In the registry since
- 2017
- Specialties on file
- 2
Practice location Address checks out
8616 Northern AveRockford, IL 61107-5309
Phone: (815) 332-8003
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Pin is approximate — placed at the ZIP-code centre, not the exact door.
Specialties & licences
| Counselor (primary) | Taxonomy 101Y00000X |
|---|---|
| Behavior Technician | Taxonomy 106S00000X |
Record details
| NPI number | 1467986331 |
|---|---|
| Entity type | Individual (Type 1) |
| Gender | Female |
| Sole proprietor | Yes |
| NPI enumerated | April 17, 2017 |
| Last updated in NPPES | August 3, 2018 |
| Mailing address | 1021 N Mulford Rd, Rockford, IL 61107-3877 |
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