Provider Demographics
NPI:1487384806
Name:HAUGEN, WYATT (CSWS-BC)
Entity type:Individual
Prefix:
First Name:WYATT
Middle Name:
Last Name:HAUGEN
Suffix:
Gender:M
Credentials:CSWS-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 27
Mailing Address - Street 2:
Mailing Address - City:MONTEVIDEO
Mailing Address - State:MN
Mailing Address - Zip Code:56265-0027
Mailing Address - Country:US
Mailing Address - Phone:320-226-5416
Mailing Address - Fax:
Practice Address - Street 1:416 N 1ST ST STE 2
Practice Address - Street 2:
Practice Address - City:MONTEVIDEO
Practice Address - State:MN
Practice Address - Zip Code:56265-1408
Practice Address - Country:US
Practice Address - Phone:320-226-5416
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-06-17
Last Update Date:2025-10-10
Deactivation Date:2022-10-03
Deactivation Code:
Reactivation Date:2025-10-08
Provider Licenses
StateLicense IDTaxonomies
MN174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist