Provider Demographics
NPI:1306598446
Name:MARQUETTE UNIVERSITY
Entity type:Organization
Organization Name:MARQUETTE UNIVERSITY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:EMILY
Authorized Official - Middle Name:
Authorized Official - Last Name:MAZZULLA
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:414-288-8464
Mailing Address - Street 1:604 N 16TH ST
Mailing Address - Street 2:
Mailing Address - City:MILWAUKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53233-2117
Mailing Address - Country:US
Mailing Address - Phone:414-288-3487
Mailing Address - Fax:
Practice Address - Street 1:604 N 16TH ST
Practice Address - Street 2:
Practice Address - City:MILWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53233-2117
Practice Address - Country:US
Practice Address - Phone:414-288-3487
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:MARQUETTE UNIVERSITY
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2022-01-20
Last Update Date:2022-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Multi-Specialty