Healthcare Provider Details

I. General information

NPI: 1942069885
Provider Name (Legal Business Name): MARISA DODGE
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/14/2024
Last Update Date: 09/14/2026
Certification Date: 09/14/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2121 SW CHELSEA DR
TOPEKA KS
66614-1756
US

IV. Provider business mailing address

2121 SW CHELSEA DR
TOPEKA KS
66614-1756
US

V. Phone/Fax

Practice location:
  • Phone: 785-291-9644
  • Fax:
Mailing address:
  • Phone: 785-291-9644
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number04898
License Number StateKS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: