Provider Demographics
NPI:1275039778
Name:DODD, MARILYN MARIE (MHC)
Entity Type:Individual
Prefix:
First Name:MARILYN
Middle Name:MARIE
Last Name:DODD
Suffix:
Gender:F
Credentials:MHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1102 FELLOWS ST
Mailing Address - Street 2:
Mailing Address - City:SOUTH BEND
Mailing Address - State:IN
Mailing Address - Zip Code:46601-3514
Mailing Address - Country:US
Mailing Address - Phone:574-233-9491
Mailing Address - Fax:574-999-1042
Practice Address - Street 1:1102 FELLOWS ST
Practice Address - Street 2:
Practice Address - City:SOUTH BEND
Practice Address - State:IN
Practice Address - Zip Code:46601-3514
Practice Address - Country:US
Practice Address - Phone:574-233-9491
Practice Address - Fax:574-999-1042
Is Sole Proprietor?:Yes
Enumeration Date:2018-04-03
Last Update Date:2018-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator