Provider Demographics
NPI:1750115630
Name:PIASECKI, MARISSA RAE (RBT)
Entity type:Individual
Prefix:MISS
First Name:MARISSA
Middle Name:RAE
Last Name:PIASECKI
Suffix:
Gender:F
Credentials:RBT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:602 17TH ST
Mailing Address - Street 2:
Mailing Address - City:MOSINEE
Mailing Address - State:WI
Mailing Address - Zip Code:54455-1031
Mailing Address - Country:US
Mailing Address - Phone:715-551-4410
Mailing Address - Fax:
Practice Address - Street 1:4215 31ST AVE S STE A
Practice Address - Street 2:
Practice Address - City:FARGO
Practice Address - State:ND
Practice Address - Zip Code:58104-7743
Practice Address - Country:US
Practice Address - Phone:701-478-0221
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-08-31
Last Update Date:2024-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WIRBT-24-355102106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician