Healthcare Provider Details

I. General information

NPI: 1710779822
Provider Name (Legal Business Name): EMMA RAE HAASE
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/22/2025
Last Update Date: 05/13/2026
Certification Date: 05/13/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5807 A ST STE 103
SPRINGFIELD OR
97478-5654
US

IV. Provider business mailing address

1075 WASHINGTON ST
EUGENE OR
97401-4606
US

V. Phone/Fax

Practice location:
  • Phone: 541-321-2278
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: