Provider Demographics
NPI:1093995953
Name:HAUGEN, JENNIFER MARIE (MSW LICSW)
Entity Type:Individual
Prefix:MRS
First Name:JENNIFER
Middle Name:MARIE
Last Name:HAUGEN
Suffix:
Gender:F
Credentials:MSW LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:948 STEVENS DR
Mailing Address - Street 2:SUITE C
Mailing Address - City:RICHLAND
Mailing Address - State:WA
Mailing Address - Zip Code:99352-3547
Mailing Address - Country:US
Mailing Address - Phone:509-946-1020
Mailing Address - Fax:509-946-0827
Practice Address - Street 1:948 STEVENS DR
Practice Address - Street 2:SUITE C
Practice Address - City:RICHLAND
Practice Address - State:WA
Practice Address - Zip Code:99352-3547
Practice Address - Country:US
Practice Address - Phone:509-946-1020
Practice Address - Fax:509-946-0827
Is Sole Proprietor?:No
Enumeration Date:2007-11-08
Last Update Date:2007-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WALW000066211041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical