Provider Demographics
NPI:1821009101
Name:HAASE, DESA C (MS CCC SLP)
Entity Type:Individual
Prefix:MRS
First Name:DESA
Middle Name:C
Last Name:HAASE
Suffix:
Gender:F
Credentials:MS CCC SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:214 CENTERVIEW DR
Mailing Address - Street 2:SUITE 150
Mailing Address - City:BRENTWOOD
Mailing Address - State:TN
Mailing Address - Zip Code:37027-5274
Mailing Address - Country:US
Mailing Address - Phone:615-370-4977
Mailing Address - Fax:615-370-9412
Practice Address - Street 1:214 CENTERVIEW DR
Practice Address - Street 2:SUITE 150
Practice Address - City:BRENTWOOD
Practice Address - State:TN
Practice Address - Zip Code:37027-5274
Practice Address - Country:US
Practice Address - Phone:615-370-4977
Practice Address - Fax:615-370-9412
Is Sole Proprietor?:No
Enumeration Date:2006-08-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3051222OtherBCBST