Lodge, Marissa Lee

Lodge, Marissa Lee is an sole proprietor health care provider with primary practice located at 8616 Northern Ave , Rockford IL 61107-5309. She recently has 2 registered licenses in different health care specialties including Behavioral Health & Social Service Providers / Behavior Technician, Behavioral Health & Social Service Providers / Counselor. Behavioral Health & Social Service Providers / Counselor is her primary health care specialty. Lodge, Marissa Lee can be contacted via phone (815) 332-8003.

Contact Information

Primary practice address
8616 Northern Ave Rockford IL 61107-5309
Phone: (815) 332-8003
Fax:
Website:
Map and Directions

Health care specialties

SpecialtyCodeLicense #State
Behavioral Health & Social Service Providers / Behavior Technician 106S00000X
Behavioral Health & Social Service Providers / Counselor 101Y00000X

Profile Details

NPI number 1467986331
LBN Legal business name Lodge, Marissa Lee
Credentials
Entity Individual
Sole proprietor 1 Yes
Enumeration date Apr 17th, 2017
Last updated Aug 3rd, 2018 - about 8 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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