Provider Demographics
NPI:1669777900
Name:TRAUTMANN, MARIAN JOSEPHINE (MSE, LICSW)
Entity type:Individual
Prefix:MRS
First Name:MARIAN
Middle Name:JOSEPHINE
Last Name:TRAUTMANN
Suffix:
Gender:F
Credentials:MSE, LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13637 60TH ST SW
Mailing Address - Street 2:
Mailing Address - City:COKATO
Mailing Address - State:MN
Mailing Address - Zip Code:55321-4210
Mailing Address - Country:US
Mailing Address - Phone:320-286-2992
Mailing Address - Fax:320-286-5140
Practice Address - Street 1:13637 60TH ST SW
Practice Address - Street 2:
Practice Address - City:COKATO
Practice Address - State:MN
Practice Address - Zip Code:55321-4210
Practice Address - Country:US
Practice Address - Phone:320-286-2992
Practice Address - Fax:320-286-5140
Is Sole Proprietor?:No
Enumeration Date:2011-01-18
Last Update Date:2011-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN84261041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical