Provider Demographics
NPI:1831514884
Name:RODGERS, MARRIKA
Entity type:Individual
Prefix:
First Name:MARRIKA
Middle Name:
Last Name:RODGERS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5911 N LOVERS LANE RD
Mailing Address - Street 2:106
Mailing Address - City:MILWAUKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53225-2250
Mailing Address - Country:US
Mailing Address - Phone:414-803-2611
Mailing Address - Fax:
Practice Address - Street 1:5911 N LOVERS LANE RD
Practice Address - Street 2:106
Practice Address - City:MILWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53225-2250
Practice Address - Country:US
Practice Address - Phone:414-803-2611
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-02-27
Last Update Date:2014-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI2051-226101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health