Provider Demographics
NPI:1548504186
Name:HAUKENES, IVA (MS CCC-SLP)
Entity type:Individual
Prefix:MS
First Name:IVA
Middle Name:
Last Name:HAUKENES
Suffix:
Gender:F
Credentials:MS CCC-SLP
Other - Prefix:MS
Other - First Name:IVA
Other - Middle Name:
Other - Last Name:FEDDERSEN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:8523 67TH AVE E
Mailing Address - Street 2:
Mailing Address - City:PUYALLUP
Mailing Address - State:WA
Mailing Address - Zip Code:98371-6405
Mailing Address - Country:US
Mailing Address - Phone:253-250-1293
Mailing Address - Fax:
Practice Address - Street 1:214 W MAIN
Practice Address - Street 2:
Practice Address - City:PUYALLUP
Practice Address - State:WA
Practice Address - Zip Code:98371-5328
Practice Address - Country:US
Practice Address - Phone:253-841-8753
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-11-20
Last Update Date:2012-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA00002768235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist