Provider Demographics
NPI:1538554894
Name:HAUGEN-LEWIS, ASHLEE A
Entity type:Individual
Prefix:
First Name:ASHLEE
Middle Name:A
Last Name:HAUGEN-LEWIS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:ASHLEE
Other - Middle Name:A
Other - Last Name:HAUGEN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:10629 JEREMIAH WAY
Mailing Address - Street 2:
Mailing Address - City:ELGIN
Mailing Address - State:OK
Mailing Address - Zip Code:73538-3827
Mailing Address - Country:US
Mailing Address - Phone:480-510-4965
Mailing Address - Fax:
Practice Address - Street 1:4121 W GORE
Practice Address - Street 2:
Practice Address - City:LAWTON
Practice Address - State:OK
Practice Address - Zip Code:73507
Practice Address - Country:US
Practice Address - Phone:580-357-3857
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-04-03
Last Update Date:2015-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst