Provider Demographics
NPI:1609902915
Name:HAUGLAND, JENNIFER M (MS, LMHC)
Entity type:Individual
Prefix:MS
First Name:JENNIFER
Middle Name:M
Last Name:HAUGLAND
Suffix:
Gender:F
Credentials:MS, LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 152
Mailing Address - Street 2:
Mailing Address - City:CARLSBORG
Mailing Address - State:WA
Mailing Address - Zip Code:98324-0152
Mailing Address - Country:US
Mailing Address - Phone:360-461-2114
Mailing Address - Fax:
Practice Address - Street 1:976 HEUSLEIN RD
Practice Address - Street 2:
Practice Address - City:PORT ANGELES
Practice Address - State:WA
Practice Address - Zip Code:98362-9509
Practice Address - Country:US
Practice Address - Phone:360-461-2114
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WALH00009037101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health