1427024678 NPI number — KARLA J. DEGARMO-HAAKENSON LCSW

Table of content: KARLA J. DEGARMO-HAAKENSON LCSW (NPI 1427024678)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1427024678 NPI number — KARLA J. DEGARMO-HAAKENSON LCSW

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
DEGARMO-HAAKENSON
Provider First Name:
KARLA
Provider Middle Name:
J.
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
LCSW
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
HAAKENSON
Provider Other First Name:
KARLA
Provider Other Middle Name:
J.
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
LCSW
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1427024678
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/21/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2825 PRAIRIE AVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
BELOIT
Provider Business Mailing Address State Name:
WI
Provider Business Mailing Address Postal Code:
53511-1844
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
608-368-3320
Provider Business Mailing Address Fax Number:
608-365-2709

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2825 PRAIRIE AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
BELOIT
Provider Business Practice Location Address State Name:
WI
Provider Business Practice Location Address Postal Code:
53511-1844
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
608-368-3320
Provider Business Practice Location Address Fax Number:
608-365-2709
Provider Enumeration Date:
02/27/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 101YM0800X , with the licence number:  1535-123 , registered in the state of WI ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 1041C0700X , with the licence number: 1535-123 , registered in the state of WI ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 40913800 , issued by the state of ( WI ) . This identifiers is of the category "MEDICAID".
  • Identifier: HAAKEKAR-MO . This is a "MERCYCARE INSURANCE" identifier , issued by the state of ( WI ) . This identifiers is of the category "OTHER".
  • Identifier: 1427024678 . This is a "BCBSWI" identifier , issued by the state of ( WI ) . This identifiers is of the category "OTHER".
  • Identifier: 1427024678 , issued by the state of ( WI ) . This identifiers is of the category "MEDICAID".
  • Identifier: 84908-0054 . This is a "WI MEDICARE" identifier , issued by the state of ( WI ) . This identifiers is of the category "OTHER".




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