Healthcare Provider Details

I. General information

NPI: 1386569317
Provider Name (Legal Business Name): ANDREE MARIE MARCUS-RADER LSWAIC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/11/2026
Last Update Date: 08/11/2026
Certification Date: 08/11/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

727 S GRAND AVE
PULLMAN WA
99163-2136
US

IV. Provider business mailing address

PO BOX 134
PALOUSE WA
99161-0134
US

V. Phone/Fax

Practice location:
  • Phone: 208-882-2566
  • Fax:
Mailing address:
  • Phone: 509-592-5712
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code104100000X
TaxonomySocial Worker
License Number2081517
License Number StateID
# 2
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License NumberSWIA.SC.70149988
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: