Provider Demographics
NPI:1861655334
Name:HAGGARD, RENA CONNIE
Entity Type:Individual
Prefix:
First Name:RENA
Middle Name:CONNIE
Last Name:HAGGARD
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 1:3133 N. MILLBROOK
Mailing Address - Street 2:
Mailing Address - City:FRESNO
Mailing Address - State:CA
Mailing Address - Zip Code:93703-4020
Mailing Address - Country:US
Mailing Address - Phone:559-453-8918
Mailing Address - Fax:559-453-8918
Practice Address - Street 1:3133 N MILLBROOK AVE
Practice Address - Street 2:
Practice Address - City:FRESNO
Practice Address - State:CA
Practice Address - Zip Code:93703-1425
Practice Address - Country:US
Practice Address - Phone:559-453-8918
Practice Address - Fax:559-453-6733
Is Sole Proprietor?:Yes
Enumeration Date:2008-07-05
Last Update Date:2010-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
No104100000XBehavioral Health & Social Service ProvidersSocial Worker