Provider Demographics
NPI:1194037051
Name:BODIKER, MARISSA HURD (MS, CCC-SLP)
Entity Type:Individual
Prefix:
First Name:MARISSA
Middle Name:HURD
Last Name:BODIKER
Suffix:
Gender:F
Credentials:MS, CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11140 HIGHWAY 55
Mailing Address - Street 2:SUITE C
Mailing Address - City:PLYMOUTH
Mailing Address - State:MN
Mailing Address - Zip Code:55441-6016
Mailing Address - Country:US
Mailing Address - Phone:763-595-0812
Mailing Address - Fax:763-595-0824
Practice Address - Street 1:11140 HIGHWAY 55
Practice Address - Street 2:SUITE C
Practice Address - City:PLYMOUTH
Practice Address - State:MN
Practice Address - Zip Code:55441-6016
Practice Address - Country:US
Practice Address - Phone:763-595-0812
Practice Address - Fax:763-595-0824
Is Sole Proprietor?:No
Enumeration Date:2010-07-08
Last Update Date:2010-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN8653235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist