Healthcare Provider Details

I. General information

NPI: 1396518866
Provider Name (Legal Business Name): REBECCA LYNNE MARRAZZO LPC, SACIT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/06/2023
Last Update Date: 06/18/2026
Certification Date: 06/18/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1835 E EDGEWOOD DR STE 105107
APPLETON WI
54913-9407
US

IV. Provider business mailing address

752 REED ST
NEENAH WI
54956-3431
US

V. Phone/Fax

Practice location:
  • Phone: 920-234-6842
  • Fax:
Mailing address:
  • Phone: 920-450-8218
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number11989-125
License Number StateWI
# 2
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number20392-130
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: