Provider Demographics
NPI:1457958498
Name:HAASL, CAROL RUTH (CHW)
Entity Type:Individual
Prefix:MRS
First Name:CAROL
Middle Name:RUTH
Last Name:HAASL
Suffix:
Gender:F
Credentials:CHW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:201 S 3RD AVE FL 2
Mailing Address - Street 2:
Mailing Address - City:VIRGINIA
Mailing Address - State:MN
Mailing Address - Zip Code:55792-2634
Mailing Address - Country:US
Mailing Address - Phone:218-471-7339
Mailing Address - Fax:
Practice Address - Street 1:215 W 4TH AVE N
Practice Address - Street 2:
Practice Address - City:AURORA
Practice Address - State:MN
Practice Address - Zip Code:55705-1252
Practice Address - Country:US
Practice Address - Phone:218-750-7175
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-10-02
Last Update Date:2020-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes172V00000XOther Service ProvidersCommunity Health WorkerGroup - Single Specialty