Provider Demographics
NPI:1679968341
Name:CYNTHIA J. HAAKANA, LLC
Entity Type:Organization
Organization Name:CYNTHIA J. HAAKANA, LLC
Other - Org Name:CYNTHIA J. HAAKANA, PH.D., L.P.
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:CYNTHIA
Authorized Official - Middle Name:JANE
Authorized Official - Last Name:HAAKANA
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:952-928-0618
Mailing Address - Street 1:4500 PARK GLEN RD STE 155
Mailing Address - Street 2:
Mailing Address - City:ST LOUIS PARK
Mailing Address - State:MN
Mailing Address - Zip Code:55416-4888
Mailing Address - Country:US
Mailing Address - Phone:952-928-0618
Mailing Address - Fax:
Practice Address - Street 1:4500 PARK GLEN RD STE 155
Practice Address - Street 2:
Practice Address - City:ST LOUIS PARK
Practice Address - State:MN
Practice Address - Zip Code:55416-4888
Practice Address - Country:US
Practice Address - Phone:952-928-0618
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-03-31
Last Update Date:2015-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNLP1056103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN393050500Medicaid
MN393050500Medicaid