Basic Information
| Provider Information | |||||||||
| NPI: | 1689077935 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | HAUGEN | ||||||||
| FirstName: | CHERISE | ||||||||
| MiddleName: | |||||||||
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| Credential: | MSW, LICSW | ||||||||
| OtherOrganizationName: | |||||||||
| OtherOrganizationType: | |||||||||
| OtherLastName: | RUSSELL | ||||||||
| OtherFirstName: | CHERISE | ||||||||
| OtherMiddleName: | |||||||||
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| OtherLastNameType: | 1 | ||||||||
| Mailing Information | |||||||||
| Address1: | 1900 SILVER LAKE RD NW STE 110 | ||||||||
| Address2: | |||||||||
| City: | NEW BRIGHTON | ||||||||
| State: | MN | ||||||||
| PostalCode: | 551121789 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6516289566 | ||||||||
| FaxNumber: | 6516280411 | ||||||||
| Practice Location | |||||||||
| Address1: | 101 JEFFERSON BLVD STE A | ||||||||
| Address2: | |||||||||
| City: | BIG LAKE | ||||||||
| State: | MN | ||||||||
| PostalCode: | 553099572 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7633676080 | ||||||||
| FaxNumber: | 7632637897 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/01/2014 | ||||||||
| LastUpdateDate: | 07/21/2022 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 1041C0700X | 20645 | MN | Y | Behavioral Health & Social Service Providers | Social Worker | Clinical |
No ID Information.