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NPI Code Detail

MEDICARE: DR. MARY PATRICIA TRAXLER PH.D.

MEDICARE: DR. MARY PATRICIA TRAXLER PH.D.
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1103TC0700XClinical PsychologistPY 60321381WA

General Provider Information

NPI Number : 1558791418
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. MARY PATRICIA TRAXLER PH.D.
Provider Business Mailing Address
First Line : 1718 NW 56TH ST
Second Line : SUITE 203
City : SEATTLE
State : WA
Zip : 98107-5237
Country : US
Telephone Number : 206-706-2533
Fax Number :
Provider Business Practice Location Address
First Line : 1718 NW 56TH ST
Second Line : SUITE 203
City : SEATTLE
State : WA
Zip : 98107-5237
Country : US
Telephone Number : 206-706-2533
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 11/13/2013
Last Update Date : 11/13/2013

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