Provider Demographics
NPI:1437148244
Name:HAIDLE, JOY M LARSEN (MS, CGC)
Entity type:Individual
Prefix:MS
First Name:JOY
Middle Name:M LARSEN
Last Name:HAIDLE
Suffix:
Gender:F
Credentials:MS, CGC
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3435 W BROADWAY AVE
Mailing Address - Street 2:SUITE 1135
Mailing Address - City:ROBBINSDALE
Mailing Address - State:MN
Mailing Address - Zip Code:55422-2922
Mailing Address - Country:US
Mailing Address - Phone:763-530-3815
Mailing Address - Fax:763-520-1976
Practice Address - Street 1:3435 W BROADWAY AVE
Practice Address - Street 2:SUITE 1135
Practice Address - City:ROBBINSDALE
Practice Address - State:MN
Practice Address - Zip Code:55422-2922
Practice Address - Country:US
Practice Address - Phone:763-530-3815
Practice Address - Fax:763-520-1976
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-10-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes170300000XOther Service ProvidersGenetic Counselor, MS