Provider Demographics
NPI:1003266677
Name:HAUGEN, LACEY ANN (DO)
Entity Type:Individual
Prefix:
First Name:LACEY
Middle Name:ANN
Last Name:HAUGEN
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:LACEY
Other - Middle Name:ANN
Other - Last Name:WOOD
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:9500 EUCLID AVE DEPT OF
Mailing Address - Street 2:
Mailing Address - City:CLEVELAND
Mailing Address - State:OH
Mailing Address - Zip Code:44195-0001
Mailing Address - Country:US
Mailing Address - Phone:216-444-4674
Mailing Address - Fax:216-445-2536
Practice Address - Street 1:9500 EUCLID AVE DEPT OF
Practice Address - Street 2:
Practice Address - City:CLEVELAND
Practice Address - State:OH
Practice Address - Zip Code:44195-0001
Practice Address - Country:US
Practice Address - Phone:216-444-4674
Practice Address - Fax:216-445-2536
Is Sole Proprietor?:No
Enumeration Date:2016-06-15
Last Update Date:2022-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL123.071190207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology