Healthcare Provider Details

I. General information

NPI: 1568599777
Provider Name (Legal Business Name): IRENE HAAKMAN CCC.SLP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/27/2007
Last Update Date: 10/26/2023
Certification Date: 10/26/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4630 17TH ST
SARASOTA FL
34235-1843
US

IV. Provider business mailing address

4630 17TH ST
SARASOTA FL
34235-1843
US

V. Phone/Fax

Practice location:
  • Phone: 941-487-5400
  • Fax:
Mailing address:
  • Phone: 941-487-5400
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code104100000X
TaxonomySocial Worker
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code222Q00000X
TaxonomyDevelopmental Therapist
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License NumberSA 7299
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: