Provider Demographics
NPI:1689089237
Name:HAGGITH, JENA (LADC, BS)
Entity Type:Individual
Prefix:
First Name:JENA
Middle Name:
Last Name:HAGGITH
Suffix:
Gender:F
Credentials:LADC, BS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1316 BOARDWALK AVE
Mailing Address - Street 2:
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55411-3364
Mailing Address - Country:US
Mailing Address - Phone:262-894-1089
Mailing Address - Fax:
Practice Address - Street 1:1901 44TH AVE N
Practice Address - Street 2:
Practice Address - City:MINNEAPOLIS
Practice Address - State:MN
Practice Address - Zip Code:55412-1209
Practice Address - Country:US
Practice Address - Phone:612-677-2671
Practice Address - Fax:612-767-6603
Is Sole Proprietor?:No
Enumeration Date:2014-06-23
Last Update Date:2014-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN303684101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)