Provider Demographics
NPI:1669521266
Name:BRABANSKI, MARIANNE M (MS)
Entity type:Individual
Prefix:
First Name:MARIANNE
Middle Name:M
Last Name:BRABANSKI
Suffix:
Gender:F
Credentials:MS
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 298
Mailing Address - Street 2:
Mailing Address - City:COUPEVILLE
Mailing Address - State:WA
Mailing Address - Zip Code:98239-0298
Mailing Address - Country:US
Mailing Address - Phone:360-678-1423
Mailing Address - Fax:360-678-1769
Practice Address - Street 1:107 S MAIN ST
Practice Address - Street 2:BLDG. A
Practice Address - City:COUPEVILLE
Practice Address - State:WA
Practice Address - Zip Code:98239-3541
Practice Address - Country:US
Practice Address - Phone:360-678-1423
Practice Address - Fax:360-678-1769
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WACD00002369231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA9038340Medicaid
WA7108137Medicaid
WAAB23303Medicare ID - Type Unspecified