Healthcare Provider Details

I. General information

NPI: 1750541223
Provider Name (Legal Business Name): MARNEE WYN MILNER J.D., PH.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/09/2008
Last Update Date: 06/09/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

216 1ST AVE S SUITE 333
SEATTLE WA
98104-3441
US

IV. Provider business mailing address

216 1ST AVE S SUITE 333
SEATTLE WA
98104-3441
US

V. Phone/Fax

Practice location:
  • Phone: 206-548-4709
  • Fax: 206-548-4710
Mailing address:
  • Phone: 206-548-4709
  • Fax: 206-548-4710

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103G00000X
TaxonomyClinical Neuropsychologist
License NumberPY00003746
License Number StateWA
# 2
Primary TaxonomyN
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License NumberPY00003746
License Number StateWA
# 3
Primary TaxonomyN
Taxonomy Code103TF0200X
TaxonomyForensic Psychologist
License NumberPY00003746
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: