Provider Demographics
NPI:1336475474
Name:HASS, SHARON M (NCC)
Entity Type:Individual
Prefix:MS
First Name:SHARON
Middle Name:M
Last Name:HASS
Suffix:
Gender:F
Credentials:NCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:708 COBBLESTONE WAY
Mailing Address - Street 2:
Mailing Address - City:WATERTOWN
Mailing Address - State:WI
Mailing Address - Zip Code:53094-6068
Mailing Address - Country:US
Mailing Address - Phone:920-262-0536
Mailing Address - Fax:
Practice Address - Street 1:708 COBBLESTONE WAY
Practice Address - Street 2:
Practice Address - City:WATERTOWN
Practice Address - State:WI
Practice Address - Zip Code:53094-6068
Practice Address - Country:US
Practice Address - Phone:920-262-0536
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-10-24
Last Update Date:2009-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI4034-125101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional