Provider Demographics
NPI:1619319191
Name:HAUGHTON, SANDRA (LLP)
Entity Type:Individual
Prefix:
First Name:SANDRA
Middle Name:
Last Name:HAUGHTON
Suffix:
Gender:F
Credentials:LLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2806 DAVENPORT AVE
Mailing Address - Street 2:
Mailing Address - City:SAGINAW
Mailing Address - State:MI
Mailing Address - Zip Code:48602-3734
Mailing Address - Country:US
Mailing Address - Phone:989-790-7500
Mailing Address - Fax:989-790-8037
Practice Address - Street 1:2806 DAVENPORT AVE
Practice Address - Street 2:
Practice Address - City:SAGINAW
Practice Address - State:MI
Practice Address - Zip Code:48602-3734
Practice Address - Country:US
Practice Address - Phone:989-790-7500
Practice Address - Fax:989-790-8037
Is Sole Proprietor?:No
Enumeration Date:2013-07-24
Last Update Date:2013-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6301002944103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical