Provider Demographics
NPI:1164692505
Name:MOY, STEVEN N (BC-HIS)
Entity Type:Individual
Prefix:MR
First Name:STEVEN
Middle Name:N
Last Name:MOY
Suffix:
Gender:M
Credentials:BC-HIS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:222 E MAIN ST
Mailing Address - Street 2:SUITE 108
Mailing Address - City:ANOKA
Mailing Address - State:MN
Mailing Address - Zip Code:55303-1771
Mailing Address - Country:US
Mailing Address - Phone:763-421-4234
Mailing Address - Fax:763-421-2135
Practice Address - Street 1:222 E MAIN ST
Practice Address - Street 2:SUITE 108
Practice Address - City:ANOKA
Practice Address - State:MN
Practice Address - Zip Code:55303-1771
Practice Address - Country:US
Practice Address - Phone:763-421-4234
Practice Address - Fax:763-421-2135
Is Sole Proprietor?:Yes
Enumeration Date:2008-02-29
Last Update Date:2009-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN2316237700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes237700000XSpeech, Language and Hearing Service ProvidersHearing Instrument Specialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN474521300OtherMEDICAL ASSISTANCE