Provider Demographics
NPI:1043489891
Name:HAYENGA, CHAD A (MA, LMFT)
Entity type:Individual
Prefix:MR
First Name:CHAD
Middle Name:A
Last Name:HAYENGA
Suffix:
Gender:M
Credentials:MA, LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:566 BAVARIA LN
Mailing Address - Street 2:PO BOX 71
Mailing Address - City:CHASKA
Mailing Address - State:MN
Mailing Address - Zip Code:55318-4597
Mailing Address - Country:US
Mailing Address - Phone:952-448-3625
Mailing Address - Fax:952-448-3625
Practice Address - Street 1:566 BAVARIA LN
Practice Address - Street 2:BOX 71
Practice Address - City:CHASKA
Practice Address - State:MN
Practice Address - Zip Code:55318-4597
Practice Address - Country:US
Practice Address - Phone:952-448-3625
Practice Address - Fax:952-448-3625
Is Sole Proprietor?:No
Enumeration Date:2008-02-26
Last Update Date:2008-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN1485106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist