Healthcare Provider Details

I. General information

NPI: 1679058895
Provider Name (Legal Business Name): KATELIN ANN HAUGAN BCBA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/03/2018
Last Update Date: 08/17/2026
Certification Date: 08/17/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

600 KITSAP ST STE 103
PORT ORCHARD WA
98366-5341
US

IV. Provider business mailing address

3296 SW PIER LN
PORT ORCHARD WA
98367-6029
US

V. Phone/Fax

Practice location:
  • Phone: 253-334-5775
  • Fax:
Mailing address:
  • Phone: 253-509-2639
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License NumberLBA.BA.70169304
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: