Provider Demographics
NPI:1891081956
Name:HAUGEN, KERIEN LYNN (LMP)
Entity Type:Individual
Prefix:
First Name:KERIEN
Middle Name:LYNN
Last Name:HAUGEN
Suffix:
Gender:F
Credentials:LMP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7700 PIONEER WAY
Mailing Address - Street 2:
Mailing Address - City:GIG HARBOR
Mailing Address - State:WA
Mailing Address - Zip Code:98335-1156
Mailing Address - Country:US
Mailing Address - Phone:253-509-0258
Mailing Address - Fax:
Practice Address - Street 1:7700 PIONEER WAY
Practice Address - Street 2:
Practice Address - City:GIG HARBOR
Practice Address - State:WA
Practice Address - Zip Code:98335-1156
Practice Address - Country:US
Practice Address - Phone:253-509-0258
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-06-27
Last Update Date:2011-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA60223146225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist