Provider Demographics
NPI:1336293950
Name:HAUGEN, LYNN M (MS, CCC-SLP)
Entity Type:Individual
Prefix:
First Name:LYNN
Middle Name:M
Last Name:HAUGEN
Suffix:
Gender:F
Credentials:MS, CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3600 HILLSIDE RD
Mailing Address - Street 2:
Mailing Address - City:MANDAN
Mailing Address - State:ND
Mailing Address - Zip Code:58554-1477
Mailing Address - Country:US
Mailing Address - Phone:701-663-2353
Mailing Address - Fax:
Practice Address - Street 1:905 8TH AVE NW
Practice Address - Street 2:
Practice Address - City:MANDAN
Practice Address - State:ND
Practice Address - Zip Code:58554-2457
Practice Address - Country:US
Practice Address - Phone:701-663-9532
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-01-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ND532235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
ND58886Medicaid