Provider Demographics
NPI:1164521613
Name:HAENEL, EDITH MARIE (LICSW)
Entity Type:Individual
Prefix:MS
First Name:EDITH
Middle Name:MARIE
Last Name:HAENEL
Suffix:
Gender:F
Credentials:LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:111 E CLARK ST STE 201
Mailing Address - Street 2:
Mailing Address - City:ALBERT LEA
Mailing Address - State:MN
Mailing Address - Zip Code:56007-2420
Mailing Address - Country:US
Mailing Address - Phone:507-377-2224
Mailing Address - Fax:507-377-2224
Practice Address - Street 1:111 E CLARK ST STE 201
Practice Address - Street 2:
Practice Address - City:ALBERT LEA
Practice Address - State:MN
Practice Address - Zip Code:56007-2420
Practice Address - Country:US
Practice Address - Phone:507-377-2224
Practice Address - Fax:507-377-2224
Is Sole Proprietor?:No
Enumeration Date:2006-09-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN066291041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical