Provider Demographics
NPI:1063948263
Name:HAAGENSON, DENAE (MED, LPCC, NCC, LP)
Entity type:Individual
Prefix:
First Name:DENAE
Middle Name:
Last Name:HAAGENSON
Suffix:
Gender:F
Credentials:MED, LPCC, NCC, LP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3911 20TH AVE S
Mailing Address - Street 2:
Mailing Address - City:FARGO
Mailing Address - State:ND
Mailing Address - Zip Code:58103-4705
Mailing Address - Country:US
Mailing Address - Phone:701-271-1613
Mailing Address - Fax:701-235-7359
Practice Address - Street 1:412 DEMERS AVE
Practice Address - Street 2:
Practice Address - City:GRAND FORKS
Practice Address - State:ND
Practice Address - Zip Code:58201
Practice Address - Country:US
Practice Address - Phone:701-271-1632
Practice Address - Fax:701-235-7359
Is Sole Proprietor?:No
Enumeration Date:2017-05-08
Last Update Date:2020-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ND1005-5-15-19101YM0800X, 101YP2500X
MNCC01782101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health