Provider Demographics
NPI:1184951782
Name:DODGE, MARCELLE N (LCSW, CSAC)
Entity type:Individual
Prefix:
First Name:MARCELLE
Middle Name:N
Last Name:DODGE
Suffix:
Gender:F
Credentials:LCSW, CSAC
Other - Prefix:
Other - First Name:MARCELLE
Other - Middle Name:N
Other - Last Name:DODGE-HASBROUCK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LCSW, CSAC
Mailing Address - Street 1:235 STATE STREET
Mailing Address - Street 2:
Mailing Address - City:ST. CROIX FALLS
Mailing Address - State:WI
Mailing Address - Zip Code:54024-4117
Mailing Address - Country:US
Mailing Address - Phone:715-483-3221
Mailing Address - Fax:715-483-0507
Practice Address - Street 1:235 E STATE ST
Practice Address - Street 2:
Practice Address - City:SAINT CROIX FALLS
Practice Address - State:WI
Practice Address - Zip Code:54024-4117
Practice Address - Country:US
Practice Address - Phone:715-483-3221
Practice Address - Fax:715-483-0507
Is Sole Proprietor?:No
Enumeration Date:2009-11-03
Last Update Date:2017-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI1232-132101YA0400X
WI3040-1231041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)