Provider Demographics
NPI:1871369009
Name:HAAS, JACQUELINE (HIS)
Entity type:Individual
Prefix:
First Name:JACQUELINE
Middle Name:
Last Name:HAAS
Suffix:
Gender:F
Credentials:HIS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2722 HERITAGE DR
Mailing Address - Street 2:
Mailing Address - City:DELAFIELD
Mailing Address - State:WI
Mailing Address - Zip Code:53018-2125
Mailing Address - Country:US
Mailing Address - Phone:262-912-0608
Mailing Address - Fax:
Practice Address - Street 1:2722 HERITAGE DR
Practice Address - Street 2:
Practice Address - City:DELAFIELD
Practice Address - State:WI
Practice Address - Zip Code:53018-2125
Practice Address - Country:US
Practice Address - Phone:262-912-0608
Practice Address - Fax:262-782-3409
Is Sole Proprietor?:No
Enumeration Date:2023-11-29
Last Update Date:2023-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI2048-60237700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes237700000XSpeech, Language and Hearing Service ProvidersHearing Instrument Specialist