1952538571 NPI number — DR. DENISE NADINE LOPEZ HAUGEN PSYD

Table of content: DR. DENISE NADINE LOPEZ HAUGEN PSYD (NPI 1952538571)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1952538571 NPI number — DR. DENISE NADINE LOPEZ HAUGEN PSYD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
LOPEZ HAUGEN
Provider First Name:
DENISE
Provider Middle Name:
NADINE
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
PSYD
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1952538571
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
06/22/2009
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
250 PRINCETON AVE
Provider Second Line Business Mailing Address:
SUITE 207
Provider Business Mailing Address City Name:
GLADSTONE
Provider Business Mailing Address State Name:
OR
Provider Business Mailing Address Postal Code:
97027-2554
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
503-723-5053
Provider Business Mailing Address Fax Number:
503-723-5052

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
250 PRINCETON AVE
Provider Second Line Business Practice Location Address:
SUITE 207
Provider Business Practice Location Address City Name:
GLADSTONE
Provider Business Practice Location Address State Name:
OR
Provider Business Practice Location Address Postal Code:
97027-2554
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
503-723-5053
Provider Business Practice Location Address Fax Number:
503-723-5052
Provider Enumeration Date:
06/22/2009

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: 103T00000X , with the licence number:  1928 , registered in the state of OR ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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