Individual provider Active NPI

Allison Jo Haack, BA, BHPP

  • Case Manager/Care Coordinator
  • Mesa, AZ
National Provider Identifier
1043616758
Registry record updated Nov 6, 2014
On this page

Key facts

NPPES NPI Registry
Primary specialty
Case Manager/Care CoordinatorTaxonomy code 171M00000X
Practice address
619 W Southern Ave
Mesa, AZ 85210-5004
Phone
(602) 808-2828
Fax
(480) 649-5214
NPI assigned
Nov 6, 2014
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Nov 6, 2014

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Case Manager/Care Coordinator 171M00000X Primary

Addresses

Primary practice location

619 W Southern Ave
Mesa, AZ 85210-5004

Mailing address

202 E Earll Dr
Suite 200
Phoenix, AZ 85012-2647
Phone (602) 599-5404

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Not enrolled
Credentials
Bachelor of Arts

Practice roles

OrganizationSpecialtyStatusNew patients
Lifewell Behavioral Wellness Past Accepting new patients

Organizations & group practices 1

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1415232000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1415232000000",
    "number": "1043616758",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "202 E EARLL DR",
            "address_2": "SUITE 200",
            "city": "PHOENIX",
            "state": "AZ",
            "postal_code": "850122647",
            "telephone_number": "602-599-5404",
            "fax_number": "602-599-5704"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "619 W SOUTHERN AVE",
            "city": "MESA",
            "state": "AZ",
            "postal_code": "852105004",
            "telephone_number": "602-808-2828",
            "fax_number": "480-649-5214"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "HAACK",
        "first_name": "ALLISON",
        "middle_name": "JO",
        "credential": "BA, BHPP",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2014-11-06",
        "last_updated": "2014-11-06",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "171M00000X",
            "taxonomy_group": "",
            "desc": "Case Manager/Care Coordinator",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Mesa, AZ

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 6, 2014; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.