Provider Demographics
NPI:1972642114
Name:HASSE, KAREN KAY (PHD, LP)
Entity Type:Individual
Prefix:
First Name:KAREN
Middle Name:KAY
Last Name:HASSE
Suffix:
Gender:F
Credentials:PHD, LP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:80 WEST 78TH STREET
Mailing Address - Street 2:SUITE 227
Mailing Address - City:CHANHASSEN
Mailing Address - State:MN
Mailing Address - Zip Code:55317-8721
Mailing Address - Country:US
Mailing Address - Phone:952-934-9175
Mailing Address - Fax:
Practice Address - Street 1:80 WEST 78TH STREET
Practice Address - Street 2:SUITE 227
Practice Address - City:CHANHASSEN
Practice Address - State:MN
Practice Address - Zip Code:55317-8721
Practice Address - Country:US
Practice Address - Phone:952-934-9175
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNLP2671103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN68550HAOtherBLUE CROSS BLUE SHIELD
MN57644HAOtherBLUE CROSS BLUE SHIELD