Provider Demographics
NPI:1528642147
Name:HAUGEN, STEPHANIE E (CSWA)
Entity type:Individual
Prefix:
First Name:STEPHANIE
Middle Name:E
Last Name:HAUGEN
Suffix:
Gender:F
Credentials:CSWA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1904 ELM ST STE 5
Mailing Address - Street 2:
Mailing Address - City:FOREST GROVE
Mailing Address - State:OR
Mailing Address - Zip Code:97116-2553
Mailing Address - Country:US
Mailing Address - Phone:503-593-4802
Mailing Address - Fax:
Practice Address - Street 1:1904 ELM ST STE 5
Practice Address - Street 2:
Practice Address - City:FOREST GROVE
Practice Address - State:OR
Practice Address - Zip Code:97116-2553
Practice Address - Country:US
Practice Address - Phone:971-405-0057
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-05-10
Last Update Date:2024-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORL115241041C0700X, 101YM0800X
101YM0800X, 1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical