Provider Demographics
NPI:1063642973
Name:KELLOGG, MARISSA ANNE (MD, MPH)
Entity Type:Individual
Prefix:DR
First Name:MARISSA
Middle Name:ANNE
Last Name:KELLOGG
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Gender:F
Credentials:MD, MPH
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Mailing Address - Street 1:3181 SW SAM JACKSON PARK RD
Mailing Address - Street 2:DEPARTMENT OF NEUROLOGY, CR120
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97239-3011
Mailing Address - Country:US
Mailing Address - Phone:503-494-5682
Mailing Address - Fax:503-494-6658
Practice Address - Street 1:3181 SW SAM JACKSON PARK RD
Practice Address - Street 2:DEPARTMENT OF NEUROLOGY, CR120
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97239-3011
Practice Address - Country:US
Practice Address - Phone:503-494-5682
Practice Address - Fax:503-494-6658
Is Sole Proprietor?:No
Enumeration Date:2009-07-27
Last Update Date:2017-03-22
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Provider Licenses
StateLicense IDTaxonomies
ORMD1619372084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology