Provider Demographics
NPI:1972209591
Name:HAENER, LORI LEE
Entity Type:Individual
Prefix:
First Name:LORI
Middle Name:LEE
Last Name:HAENER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:LORILEE
Other - Middle Name:
Other - Last Name:HAENER
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:101 240TH ST SW
Mailing Address - Street 2:
Mailing Address - City:BOTHELL
Mailing Address - State:WA
Mailing Address - Zip Code:98021-8616
Mailing Address - Country:US
Mailing Address - Phone:425-614-7032
Mailing Address - Fax:
Practice Address - Street 1:101 240TH ST SW
Practice Address - Street 2:
Practice Address - City:BOTHELL
Practice Address - State:WA
Practice Address - Zip Code:98021-8616
Practice Address - Country:US
Practice Address - Phone:425-614-7032
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-02-06
Last Update Date:2023-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA61400776101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty