Provider Demographics
NPI:1063443729
Name:HAUGE, GREGORY A (PHD)
Entity Type:Individual
Prefix:
First Name:GREGORY
Middle Name:A
Last Name:HAUGE
Suffix:
Gender:M
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 6001
Mailing Address - Street 2:
Mailing Address - City:FARGO
Mailing Address - State:ND
Mailing Address - Zip Code:58108-6001
Mailing Address - Country:US
Mailing Address - Phone:701-364-3300
Mailing Address - Fax:701-364-8906
Practice Address - Street 1:1702 UNIVERSITY DR S
Practice Address - Street 2:
Practice Address - City:FARGO
Practice Address - State:ND
Practice Address - Zip Code:58103-4940
Practice Address - Country:US
Practice Address - Phone:701-364-3300
Practice Address - Fax:701-364-8906
Is Sole Proprietor?:No
Enumeration Date:2006-07-05
Last Update Date:2012-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ND208103T00000X
MNLP4440103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
ND676706OtherAMERICA'S PPO/ARAZ #
NDND200086OtherLHS #
ND23120OtherND MEDICARE#
ND268750000Medicaid
NDDA9011026969OtherPREFERRED ONE #
ND137095OtherUCARE #
ND5342OtherNDBS #
NDHP25773OtherHEALTHPARTNERS #
ND16920Medicaid
ND36594HAOtherMNBS #
ND370J8HAOtherMNBS #
ND6134949OtherMEDICA #
ND268750000Medicaid
MN680001768Medicare ID - Type UnspecifiedMN MEDICARE#
ND620002290Medicare ID - Type UnspecifiedRR MEDICARE #
MNP00036108Medicare ID - Type UnspecifiedRR MEDICARE #
ND16920Medicaid
ND5342OtherNDBS #
ND6134949OtherMEDICA #
NDR02263Medicare UPIN
MNP00036107Medicare ID - Type UnspecifiedRR MEDICARE #