Provider Demographics
NPI:1790572295
Name:HAGGERTY, BRENNA ANN
Entity type:Individual
Prefix:
First Name:BRENNA
Middle Name:ANN
Last Name:HAGGERTY
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9501 S I 35 SERVICE RD APT 1316
Mailing Address - Street 2:
Mailing Address - City:MOORE
Mailing Address - State:OK
Mailing Address - Zip Code:73160-3157
Mailing Address - Country:US
Mailing Address - Phone:405-921-1376
Mailing Address - Fax:
Practice Address - Street 1:1211 MAGNOLIA CT
Practice Address - Street 2:
Practice Address - City:MOORE
Practice Address - State:OK
Practice Address - Zip Code:73160-1397
Practice Address - Country:US
Practice Address - Phone:405-237-3515
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-04-21
Last Update Date:2025-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician