Provider Demographics
NPI:1235708025
Name:HAUGAN, REBECCA NICOLE (MABA)
Entity Type:Individual
Prefix:MS
First Name:REBECCA
Middle Name:NICOLE
Last Name:HAUGAN
Suffix:
Gender:F
Credentials:MABA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15406 MERIDIAN E STE 103
Mailing Address - Street 2:
Mailing Address - City:PUYALLUP
Mailing Address - State:WA
Mailing Address - Zip Code:98375-9504
Mailing Address - Country:US
Mailing Address - Phone:253-200-5046
Mailing Address - Fax:
Practice Address - Street 1:15406 MERIDIAN E STE 103
Practice Address - Street 2:
Practice Address - City:PUYALLUP
Practice Address - State:WA
Practice Address - Zip Code:98375-9504
Practice Address - Country:US
Practice Address - Phone:253-200-5046
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-06-24
Last Update Date:2022-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WACB61085899106S00000X
WABA61326277103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
No106S00000XBehavioral Health & Social Service ProvidersBehavior Technician