Provider Demographics
NPI:1003046210
Name:MAGYAR-MOE, JEANA L (PHD)
Entity Type:Individual
Prefix:
First Name:JEANA
Middle Name:L
Last Name:MAGYAR-MOE
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:JEANA
Other - Middle Name:L
Other - Last Name:MAGYAR
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1547 STRONGS AVE
Mailing Address - Street 2:STE D
Mailing Address - City:STEVENS POINT
Mailing Address - State:WI
Mailing Address - Zip Code:54481-3566
Mailing Address - Country:US
Mailing Address - Phone:715-303-2900
Mailing Address - Fax:715-303-2928
Practice Address - Street 1:1547 STRONGS AVE
Practice Address - Street 2:STE D
Practice Address - City:STEVENS POINT
Practice Address - State:WI
Practice Address - Zip Code:54481-3566
Practice Address - Country:US
Practice Address - Phone:715-303-2900
Practice Address - Fax:715-303-2928
Is Sole Proprietor?:Yes
Enumeration Date:2009-07-22
Last Update Date:2020-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI2652-057103T00000X, 103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No103T00000XBehavioral Health & Social Service ProvidersPsychologist