Provider Demographics
NPI:1710766837
Name:HAATAJA, MARIA ANN
Entity Type:Individual
Prefix:
First Name:MARIA
Middle Name:ANN
Last Name:HAATAJA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16764 SHORT RD
Mailing Address - Street 2:
Mailing Address - City:PELKIE
Mailing Address - State:MI
Mailing Address - Zip Code:49958-9088
Mailing Address - Country:US
Mailing Address - Phone:906-201-1214
Mailing Address - Fax:
Practice Address - Street 1:200 QUINCY ST
Practice Address - Street 2:
Practice Address - City:HANCOCK
Practice Address - State:MI
Practice Address - Zip Code:49930-1817
Practice Address - Country:US
Practice Address - Phone:906-481-1055
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-09-27
Last Update Date:2023-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician