Provider Demographics
NPI:1497941553
Name:CHARGO, STEVEN J (MA, CCC, AUDIOLOGIST)
Entity Type:Individual
Prefix:MR
First Name:STEVEN
Middle Name:J
Last Name:CHARGO
Suffix:
Gender:M
Credentials:MA, CCC, AUDIOLOGIST
Other - Prefix:
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Other - Middle Name:
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Mailing Address - Street 1:3025 HARBOR LN N
Mailing Address - Street 2:SUITE 105
Mailing Address - City:PLYMOUTH
Mailing Address - State:MN
Mailing Address - Zip Code:55447-5119
Mailing Address - Country:US
Mailing Address - Phone:763-744-1190
Mailing Address - Fax:763-744-0547
Practice Address - Street 1:10000 ZANE AVE N
Practice Address - Street 2:
Practice Address - City:BROOKLYN PARK
Practice Address - State:MN
Practice Address - Zip Code:55443-1400
Practice Address - Country:US
Practice Address - Phone:763-744-1190
Practice Address - Fax:763-744-0547
Is Sole Proprietor?:Yes
Enumeration Date:2007-09-21
Last Update Date:2018-03-13
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MN5417231HA2400X, 231HA2500X, 237600000X, 231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist
No231HA2400XSpeech, Language and Hearing Service ProvidersAudiologistAssistive Technology Practitioner
No231HA2500XSpeech, Language and Hearing Service ProvidersAudiologistAssistive Technology Supplier
No237600000XSpeech, Language and Hearing Service ProvidersAudiologist-Hearing Aid Fitter
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN077708100Medicaid