1558760496 NPI number — NAOMI CAROLYN HASKINS MSW, LICSW

Table of content: NAOMI CAROLYN HASKINS MSW, LICSW (NPI 1558760496)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1558760496 NPI number — NAOMI CAROLYN HASKINS MSW, LICSW

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
HASKINS
Provider First Name:
NAOMI
Provider Middle Name:
CAROLYN
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
MSW, LICSW
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
FRAZER
Provider Other First Name:
NAOMI
Provider Other Middle Name:
CAROLYN
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1558760496
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
10/26/2017
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
6944 IDSEN AVE S
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
COTTAGE GROVE
Provider Business Mailing Address State Name:
MN
Provider Business Mailing Address Postal Code:
55016
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
763-438-7661
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
7580 160TH ST W
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
LAKEVILLE
Provider Business Practice Location Address State Name:
MN
Provider Business Practice Location Address Postal Code:
55044-8348
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
952-898-1133
Provider Business Practice Location Address Fax Number:
952-435-6797
Provider Enumeration Date:
08/16/2014

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: 1041C0700X , with the licence number:  20303 , registered in the state of MN ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





Copyright © 2007-2025 www.npivalidator.com