Individual ProviderLeticia HaackeSocial WorkerBehavioral Health & Social Service ProvidersPractice Address5965 S 900 E, Salt Lake City, UT 84121-1720(801) 263-7100(801) 964-3111PECOS EnrollmentBased on the most recent information from CMS, provider Leticia Haacke is legally eligible to order and refer claims for Part B and DME services only.Part BMedicare Part BEnrolledHHAHome Health AgencyNot EnrolledDMEDurable Medical EquipmentEnrolledPMDPower Mobility DeviceNot EnrolledCMS last updated its PECOS records 2 days ago.Profile DetailsProvider ID1376822098Provider TypeIndividualFull NameHaacke, LeticiaCredentialLCSWGenderFemaleSole ProprietorNoEnumeration Date8/11/2011Last Updated7/19/2023Contact InformationPractice LocationPractice Address5965 S 900 E, Salt Lake City, UT 84121-1720Phone(801) 263-7100FaxUnlisted FaxMailing LocationMailing Address4052 West 3390 South, Suite 105, West Valley City, UT 84120Phone(801) 964-3111FaxUnlisted FaxProvider TaxonomiesCodeDescriptionLicenseCode1041C0700XPrimaryDescriptionSocial WorkerBehavioral Health & Social Service ProvidersLicense8283071-3501UtahCode101YM0800XDescriptionCounselorBehavioral Health & Social Service ProvidersLicense8283071-3501Utah