Provider Demographics
NPI:1568146447
Name:ACKERMAN, MARISSA EMILY (LLMSW)
Entity Type:Individual
Prefix:
First Name:MARISSA
Middle Name:EMILY
Last Name:ACKERMAN
Suffix:
Gender:F
Credentials:LLMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:200 W SPRING ST
Mailing Address - Street 2:
Mailing Address - City:MARQUETTE
Mailing Address - State:MI
Mailing Address - Zip Code:49855-4661
Mailing Address - Country:US
Mailing Address - Phone:906-225-1181
Mailing Address - Fax:
Practice Address - Street 1:601 W SUPERIOR ST
Practice Address - Street 2:
Practice Address - City:MUNISING
Practice Address - State:MI
Practice Address - Zip Code:49862-1328
Practice Address - Country:US
Practice Address - Phone:906-387-3611
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-06-12
Last Update Date:2023-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI68511165291041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical