Alexa Haberlack, ATC

Primary specialty

Athletic TrainerTaxonomy code 2255A2300X

Practice address

346 Rodeo Dr
Moscow, ID 83843-9778

Phone

(425) 422-8302

NPI assigned

Sep 30, 2017

Last updated

Sep 30, 2017By the provider in NPPES

Sex

Female

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

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

{
    "created_epoch": "1506729600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1506729600000",
    "number": "1235649575",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "15557 168TH AVE SE",
            "city": "MONROE",
            "state": "WA",
            "postal_code": "982722887"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "346 RODEO DR",
            "city": "MOSCOW",
            "state": "ID",
            "postal_code": "838439778",
            "telephone_number": "425-422-8302"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "HABERLACK",
        "first_name": "ALEXA",
        "credential": "ATC",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2017-09-30",
        "last_updated": "2017-09-30",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2255A2300X",
            "taxonomy_group": "",
            "desc": "Specialist/Technologist, Athletic Trainer",
            "state": "ID",
            "license": "AT-592",
            "primary": false
        },
        {
            "code": "2255A2300X",
            "taxonomy_group": "",
            "desc": "Specialist/Technologist, Athletic Trainer",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Gritman Medical Center, Inc. (Moscow Family Medicine)
• Keri Ann Groseclose, LMSW
• Madison Grzeszkowiak, D.C.
• Griffin Guess, D.M.D.
• Kelly Haase, ND
• Shelbie Jean Hackett, ATS
• Kathryn Christine Hajos, MS-MHC
• Sarah Elizabeth Hall, DO
• Larry W Hammond, D.C.
• Andrew Hamstra, MS. ATC

• Athletic Trainer in Moscow, ID
• Providers in Moscow, ID by specialty
• Athletic Trainer in Idaho

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 30, 2017; 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.