Provider Demographics
NPI:1063888170
Name:HAUGEN, MEGAN ADELE (RDN)
Entity type:Individual
Prefix:MS
First Name:MEGAN
Middle Name:ADELE
Last Name:HAUGEN
Suffix:
Gender:F
Credentials:RDN
Other - Prefix:MS
Other - First Name:MEGAN
Other - Middle Name:ADELE
Other - Last Name:REARDON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1115 SE 164TH AVE
Mailing Address - Street 2:DEPT 358
Mailing Address - City:VANCOUVER
Mailing Address - State:WA
Mailing Address - Zip Code:98683-9324
Mailing Address - Country:US
Mailing Address - Phone:360-752-5601
Mailing Address - Fax:360-752-5667
Practice Address - Street 1:4465 CORDATA PKWY
Practice Address - Street 2:SUITE B
Practice Address - City:BELLINGHAM
Practice Address - State:WA
Practice Address - Zip Code:98226-8037
Practice Address - Country:US
Practice Address - Phone:360-752-5601
Practice Address - Fax:360-752-5667
Is Sole Proprietor?:No
Enumeration Date:2015-08-12
Last Update Date:2018-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA86037415133V00000X
WADI60596590133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered