Provider Demographics
NPI:1881821098
Name:COOLEY, MARISSA ELIZABETH (MSED)
Entity Type:Individual
Prefix:MS
First Name:MARISSA
Middle Name:ELIZABETH
Last Name:COOLEY
Suffix:
Gender:F
Credentials:MSED
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2 PRIVATE ROAD PQQ
Mailing Address - Street 2:
Mailing Address - City:MAKANDA
Mailing Address - State:IL
Mailing Address - Zip Code:62958-2400
Mailing Address - Country:US
Mailing Address - Phone:217-251-0611
Mailing Address - Fax:
Practice Address - Street 1:2 PRIVATE ROAD PQQ
Practice Address - Street 2:
Practice Address - City:MAKANDA
Practice Address - State:IL
Practice Address - Zip Code:62958-2400
Practice Address - Country:US
Practice Address - Phone:217-251-0611
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-06-15
Last Update Date:2009-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171W00000XOther Service ProvidersContractor