Provider Demographics
NPI:1376305334
Name:HUMBURG, MARISSA (MMT, MT-BC)
Entity Type:Individual
Prefix:
First Name:MARISSA
Middle Name:
Last Name:HUMBURG
Suffix:
Gender:F
Credentials:MMT, MT-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13529 400TH AVE
Mailing Address - Street 2:
Mailing Address - City:BLUE EARTH
Mailing Address - State:MN
Mailing Address - Zip Code:56013-5018
Mailing Address - Country:US
Mailing Address - Phone:507-995-2102
Mailing Address - Fax:
Practice Address - Street 1:13529 400TH AVE
Practice Address - Street 2:
Practice Address - City:BLUE EARTH
Practice Address - State:MN
Practice Address - Zip Code:56013-5018
Practice Address - Country:US
Practice Address - Phone:507-995-2102
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-01-25
Last Update Date:2024-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225A00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMusic Therapist