Shackleford, Marisa Luellamae
Shackleford, Marisa Luellamae is an individual health care provider with primary practice located at 218 Central Ave N , Faribault MN 55021-5278. She recently has only one registered license in Behavioral Health & Social Service Providers / Behavioral Analyst, which is considered as her primary health care specialty. Shackleford, Marisa Luellamae can be contacted via phone (507) 491-5475.Contact Information
Primary practice address
218 Central Ave N
Faribault MN 55021-5278
Phone: (507) 491-5475
Fax:
Website:
Health care specialties
| Specialty | Code | License # | State |
|---|---|---|---|
| Behavioral Health & Social Service Providers / Behavioral Analyst | 103K00000X |
Profile Details
| NPI number | 1083344246 |
|---|---|
| LBN Legal business name | Shackleford, Marisa Luellamae |
| Credentials | |
| Entity | Individual |
| Sole proprietor 1 | No |
| Enumeration date | Jun 12th, 2022 |
| Last updated | Jun 12th, 2022 - about 2 years ago |
1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.
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