MEDICARE: MS. KIM I HAEG BS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy
1	101YA0400X	Addiction (Substance Use Disorder) Counselor
2	101Y00000X	Counselor
3	171M00000X	Case Manager/Care Coordinator

General Provider Information

NPI Number	:	1255487526
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. KIM I HAEG BS

Provider Business Mailing Address
First Line	:	3262 HOLLYWOOD DR NE
Second Line	:
City	:	SALEM
State	:	OR
Zip	:	97305-1932
Country	:	US
Telephone Number	:	503-363-4587
Fax Number	:

Provider Business Practice Location Address
First Line	:	3325 HAROLD DR NE
Second Line	:
City	:	SALEM
State	:	OR
Zip	:	97305-1339
Country	:	US
Telephone Number	:	503-363-2021
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/26/2007
Last Update Date	:	01/16/2008

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