Healthcare Provider Details

I. General information

NPI: 1699190264
Provider Name (Legal Business Name): LIRENDA T HAAK LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/19/2014
Last Update Date: 02/19/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1253 NW CANAL BLVD
REDMOND OR
97756-1334
US

IV. Provider business mailing address

PO BOX 6096
BEND OR
97708-6096
US

V. Phone/Fax

Practice location:
  • Phone: 541-548-8131
  • Fax:
Mailing address:
  • Phone: 541-548-8131
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License NumberL2031
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: