MEDICARE: DR. MARNEE WYN MILNER J.D., 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
1	103G00000X	Clinical Neuropsychologist	PY00003746	WA
2	103TC0700X	Clinical Psychologist	PY00003746	WA
3	103TF0200X	Forensic Psychologist	PY00003746	WA

General Provider Information

NPI Number	:	1750541223
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MARNEE WYN MILNER J.D., PH.D.

Provider Business Mailing Address
First Line	:	216 1ST AVE S
Second Line	:	SUITE 333
City	:	SEATTLE
State	:	WA
Zip	:	98104-3441
Country	:	US
Telephone Number	:	206-548-4709
Fax Number	:	206-548-4710

Provider Business Practice Location Address
First Line	:	216 1ST AVE S
Second Line	:	SUITE 333
City	:	SEATTLE
State	:	WA
Zip	:	98104-3441
Country	:	US
Telephone Number	:	206-548-4709
Fax Number	:	206-548-4710

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/09/2008
Last Update Date	:	06/09/2008

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