Provider Demographics
NPI:1285075291
Name:HAGGERTY, JANIS (MS)
Entity type:Individual
Prefix:
First Name:JANIS
Middle Name:
Last Name:HAGGERTY
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8777 COLUMBIA CIR
Mailing Address - Street 2:
Mailing Address - City:CANTON
Mailing Address - State:MI
Mailing Address - Zip Code:48187-1354
Mailing Address - Country:US
Mailing Address - Phone:734-634-1647
Mailing Address - Fax:
Practice Address - Street 1:17177 N LAUREL PARK DR
Practice Address - Street 2:#131
Practice Address - City:LIVONIA
Practice Address - State:MI
Practice Address - Zip Code:48152-2693
Practice Address - Country:US
Practice Address - Phone:734-462-3210
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-07-08
Last Update Date:2013-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6301015533103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical