Individual provider Active NPI

Anne Marie Haugen, LMFT

  • Marriage & Family Therapist
  • Chicago, IL
National Provider Identifier
1679391569
Registry record updated Sep 30, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Marriage & Family TherapistTaxonomy code 106H00000X
License
166.001763 Issued in IL
Practice address
4043 N Ravenswood Ave Ste 301-302
Chicago, IL 60613-1155
Phone
(312) 967-4669
NPI assigned
Sep 30, 2024
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Sep 30, 2024

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Marriage & Family Therapist 106H00000X 166.001763 IL Primary

Addresses

Primary practice location

4043 N Ravenswood Ave Ste 301-302
Chicago, IL 60613-1155

Mailing address

4043 N Ravenswood Ave Ste 302
Chicago, IL 60613-5683
Phone (312) 967-4669

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

State licenses

LicenseStateTypeSpecialty
166.001763ILMDMarriage & Family Therapist

Practice roles

OrganizationSpecialtyStatusNew patients
Balanced Awakening, PC CurrentSince Oct 6, 2024 Accepting new patients

Locations

4043 N Ravenswood Ave
Ste 302
Chicago, IL 60613
Phone (312) 967-4669

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": "1727654400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1727654400000",
    "number": "1679391569",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4043 N RAVENSWOOD AVE STE 302",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606135683",
            "telephone_number": "312-967-4669"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4043 N RAVENSWOOD AVE STE 301-302",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606131155",
            "telephone_number": "312-967-4669"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "HAUGEN",
        "first_name": "ANNE MARIE",
        "name_prefix": "Mrs.",
        "credential": "LMFT",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2024-09-30",
        "last_updated": "2024-09-30",
        "certification_date": "2024-09-30",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "106H00000X",
            "taxonomy_group": "",
            "desc": "Marriage & Family Therapist",
            "state": "IL",
            "license": "166.001763",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Chicago, IL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 30, 2024; 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.