Provider Demographics
NPI:1811709447
Name:HAAGENSON, ALICIA RAYLEE
Entity type:Individual
Prefix:
First Name:ALICIA
Middle Name:RAYLEE
Last Name:HAAGENSON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11801 97TH LN NE APT 529
Mailing Address - Street 2:
Mailing Address - City:KIRKLAND
Mailing Address - State:WA
Mailing Address - Zip Code:98034-7213
Mailing Address - Country:US
Mailing Address - Phone:425-678-5133
Mailing Address - Fax:
Practice Address - Street 1:10601 NE 132ND ST
Practice Address - Street 2:
Practice Address - City:KIRKLAND
Practice Address - State:WA
Practice Address - Zip Code:98034-2824
Practice Address - Country:US
Practice Address - Phone:425-936-1600
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-01-21
Last Update Date:2025-01-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician