Provider Demographics
NPI:1235886482
Name:HASKETT, ELLISE ANN
Entity Type:Individual
Prefix:
First Name:ELLISE
Middle Name:ANN
Last Name:HASKETT
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:503 COUNTY ROAD 950 N
Mailing Address - Street 2:
Mailing Address - City:TOLEDO
Mailing Address - State:IL
Mailing Address - Zip Code:62468-3011
Mailing Address - Country:US
Mailing Address - Phone:217-273-3409
Mailing Address - Fax:
Practice Address - Street 1:503 COUNTY ROAD 950 N
Practice Address - Street 2:
Practice Address - City:TOLEDO
Practice Address - State:IL
Practice Address - Zip Code:62468-3011
Practice Address - Country:US
Practice Address - Phone:217-273-3409
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-03-08
Last Update Date:2022-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional