Provider Demographics
NPI:1942378906
Name:TRAUSE, MARYANNE STAIGERS (PHD)
Entity Type:Individual
Prefix:
First Name:MARYANNE
Middle Name:STAIGERS
Last Name:TRAUSE
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 11009
Mailing Address - Street 2:
Mailing Address - City:OLYMPIA
Mailing Address - State:WA
Mailing Address - Zip Code:98508-1009
Mailing Address - Country:US
Mailing Address - Phone:360-352-2037
Mailing Address - Fax:360-352-0637
Practice Address - Street 1:2617 12TH CT SW STE B5
Practice Address - Street 2:
Practice Address - City:OLYMPIA
Practice Address - State:WA
Practice Address - Zip Code:98502-1023
Practice Address - Country:US
Practice Address - Phone:360-352-1750
Practice Address - Fax:360-352-7881
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-30
Last Update Date:2008-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA7028798Medicaid
WA0227339OtherLABOR AND INDUSTRIES
WAPO4787Medicare UPIN
WA7028798Medicaid