Healthcare Provider Details

I. General information

NPI: 1881352920
Provider Name (Legal Business Name): SARAH M HAUGEN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/06/2021
Last Update Date: 12/06/2021
Certification Date: 12/06/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

122 DEER PATH CT
ETNA OH
43062-6004
US

IV. Provider business mailing address

122 DEER PATH CT
ETNA OH
43062-6004
US

V. Phone/Fax

Practice location:
  • Phone: 614-288-4678
  • Fax:
Mailing address:
  • Phone: 614-288-4678
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code253J00000X
TaxonomyFoster Care Agency
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code174200000X
TaxonomyMeals Provider
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: