Healthcare Provider Details

I. General information

NPI: 1437078375
Provider Name (Legal Business Name): REBECCA HAAS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/14/2026
Last Update Date: 07/14/2026
Certification Date: 07/14/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

253 8TH ST NW
ELK RIVER MN
55330-1581
US

IV. Provider business mailing address

22600 EVERTON AVE N APT 305
FOREST LAKE MN
55025-3400
US

V. Phone/Fax

Practice location:
  • Phone: 763-441-3770
  • Fax:
Mailing address:
  • Phone: 763-441-3770
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number30994
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: