Healthcare Provider Details

I. General information

NPI: 1881104123
Provider Name (Legal Business Name): MRS. KENDRA ANN HAUK
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/30/2017
Last Update Date: 03/17/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

467 CREAMERY WAY
EXTON PA
19341-2508
US

IV. Provider business mailing address

398 DEVON DR
EXTON PA
19341-1781
US

V. Phone/Fax

Practice location:
  • Phone: 610-363-1488
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License NumberBH003289
License Number StatePA

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: