Provider Demographics
NPI:1700552726
Name:HAALAND, REBECCA J (RESP THERAPIST)
Entity Type:Individual
Prefix:
First Name:REBECCA
Middle Name:J
Last Name:HAALAND
Suffix:
Gender:F
Credentials:RESP THERAPIST
Other - Prefix:
Other - First Name:BECKY
Other - Middle Name:
Other - Last Name:HAALAND
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:10384 E SUPERSTITION RANGE RD
Mailing Address - Street 2:
Mailing Address - City:GOLD CANYON
Mailing Address - State:AZ
Mailing Address - Zip Code:85118-4935
Mailing Address - Country:US
Mailing Address - Phone:605-360-8866
Mailing Address - Fax:
Practice Address - Street 1:10384 E SUPERSTITION RANGE RD
Practice Address - Street 2:
Practice Address - City:GOLD CANYON
Practice Address - State:AZ
Practice Address - Zip Code:85118-4935
Practice Address - Country:US
Practice Address - Phone:605-360-8866
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-08-19
Last Update Date:2021-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SD326642279G1100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2279G1100XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRespiratory Therapist, RegisteredGeneral Care