Doctor Name: | MARISSA HURD BODIKER |
NPI Number: | 1194037051 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | MS, CCC-SLP |
License Number: | 8653 |
Business Practice Address: | 11140 Highway 55 Suite C Plymouth, MN - 554416016 |
Business Phone Number: | 7635950812 |
Business Fax Number: | 7635950824 |
Mailing Address: | 11140 Highway 55, Suite C PLYMOUTH |
State: | MN |
Postal Code: | 554416016 |
Phone Number: | 7635950812 |
Fax Number: | 7635950824 |
NPI Enumeration Date: | 07/08/2010 |
NPI Last Update Date: | 07/08/2010 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 235Z00000X |
License Number: | 8653 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | MN |
Taxonomy Type: | Speech, Language and Hearing Service Providers |
Taxonomy Classification: | Speech-Language Pathologist |
Taxonomy Specialization: | |
Taxonomy Definition: | A speech pathologist is a person qualified by a master |