Provider Demographics
NPI:1851378988
Name:HAAG, VELMA (ACSW, CICSW)
Entity Type:Individual
Prefix:
First Name:VELMA
Middle Name:
Last Name:HAAG
Suffix:
Gender:F
Credentials:ACSW, CICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:415 N MAIN ST
Mailing Address - Street 2:
Mailing Address - City:POYNETTE
Mailing Address - State:WI
Mailing Address - Zip Code:53955-8963
Mailing Address - Country:US
Mailing Address - Phone:608-635-2146
Mailing Address - Fax:608-635-7379
Practice Address - Street 1:415 N MAIN ST
Practice Address - Street 2:
Practice Address - City:POYNETTE
Practice Address - State:WI
Practice Address - Zip Code:53955-8963
Practice Address - Country:US
Practice Address - Phone:608-635-2146
Practice Address - Fax:608-635-7379
Is Sole Proprietor?:No
Enumeration Date:2005-12-29
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI2017-1231041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI1011506OtherPHYSICIANS PLUS
WI39541400Medicaid
WI84322Medicare PIN