Active NPI
Kelly J Haakenson, AMFT
- Marriage & Family Therapist
- Auburn, CA
National Provider Identifier
1861259616
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Marriage & Family Therapist
- License
- 127074
- Practice address
- 1275 High St
Auburn, CA 95603-5016 - Phone
- (279) 599-3644
- NPI assigned
- Feb 28, 2024
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Marriage & Family Therapist | 106H00000X | 127074 | CA | Primary |
Addresses
Primary practice location
1275 High St
Auburn, CA 95603-5016
Mailing address
1275 High St
Auburn, CA 95603-5016
Phone (279) 599-3644
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
- Opted out of Medicare
- Yes, effective Mar 23, 2025 through Mar 23, 2027
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 127074 | CA | MD | Clinical Social Worker |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1709078400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1709078400000",
"number": "1861259616",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1275 HIGH ST",
"city": "AUBURN",
"state": "CA",
"postal_code": "956035016",
"telephone_number": "279-599-3644"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1275 HIGH ST",
"city": "AUBURN",
"state": "CA",
"postal_code": "956035016",
"telephone_number": "279-599-3644"
}
],
"practiceLocations": [],
"basic": {
"last_name": "HAAKENSON",
"first_name": "KELLY",
"middle_name": "J",
"credential": "AMFT",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2024-02-28",
"last_updated": "2024-02-28",
"certification_date": "2024-02-20",
"status": "A"
},
"taxonomies": [
{
"code": "106H00000X",
"taxonomy_group": "",
"desc": "Marriage & Family Therapist",
"state": "CA",
"license": "127074",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Auburn, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 28, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Opt Out Affidavits.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.