Provider Demographics
NPI:1841677820
Name:WITT-DOERRING, MARISSA HUDAK (MD)
Entity type:Individual
Prefix:
First Name:MARISSA
Middle Name:HUDAK
Last Name:WITT-DOERRING
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:MARISSA
Other - Middle Name:LAUREN
Other - Last Name:HUDAK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:345 W 600 S STE 147
Mailing Address - Street 2:
Mailing Address - City:HEBER CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84032-2247
Mailing Address - Country:US
Mailing Address - Phone:435-800-4047
Mailing Address - Fax:985-244-2466
Practice Address - Street 1:345 W 600 S STE 147
Practice Address - Street 2:
Practice Address - City:HEBER CITY
Practice Address - State:UT
Practice Address - Zip Code:84032-2247
Practice Address - Country:US
Practice Address - Phone:435-800-4047
Practice Address - Fax:985-244-2466
Is Sole Proprietor?:No
Enumeration Date:2015-04-29
Last Update Date:2023-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
MDD00874422084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program