Provider Demographics
NPI:1811538036
Name:DUNLAP, MARISA ROBBI
Entity Type:Individual
Prefix:
First Name:MARISA
Middle Name:ROBBI
Last Name:DUNLAP
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:MARISA
Other - Middle Name:ROBBI
Other - Last Name:VERTIGAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:3111 ELECTRIC AVE
Mailing Address - Street 2:
Mailing Address - City:PORT HURON
Mailing Address - State:MI
Mailing Address - Zip Code:48060-8127
Mailing Address - Country:US
Mailing Address - Phone:810-985-8900
Mailing Address - Fax:
Practice Address - Street 1:631 RICHMAN
Practice Address - Street 2:631 RICHMAN
Practice Address - City:SMITHS CREEK
Practice Address - State:MI
Practice Address - Zip Code:48074
Practice Address - Country:US
Practice Address - Phone:810-956-3056
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-09-30
Last Update Date:2019-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician