Individual
DR. LISA HAAKE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
PH.D., LMFT
Contact information
Practice address
507 W SPRINGFIELD AVE, URBANA, IL 61801-3108
(217) 721-2617
(217) 344-4733
Mailing address
1416 S SMITH RD, URBANA, IL 61802-4750
(217) 299-1342
(217) 344-4733
Taxonomy
Speciality
Code
Description
License number
State
106H00000X
Marriage & Family Therapist
Primary
—
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
01032083
BCBSIL PROVIDER ID
IL
Enumeration date
11/28/2006
Last updated
07/08/2007
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