Provider Demographics
NPI:1518738731
Name:MONETTE, MIAH CECELIA
Entity Type:Individual
Prefix:
First Name:MIAH
Middle Name:CECELIA
Last Name:MONETTE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15320 WACO CT NW
Mailing Address - Street 2:
Mailing Address - City:RAMSEY
Mailing Address - State:MN
Mailing Address - Zip Code:55303-6100
Mailing Address - Country:US
Mailing Address - Phone:763-331-2004
Mailing Address - Fax:
Practice Address - Street 1:2021 E HENNEPIN AVE STE LL20
Practice Address - Street 2:
Practice Address - City:MINNEAPOLIS
Practice Address - State:MN
Practice Address - Zip Code:55413-2738
Practice Address - Country:US
Practice Address - Phone:612-259-7711
Practice Address - Fax:612-345-4609
Is Sole Proprietor?:No
Enumeration Date:2024-01-16
Last Update Date:2024-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician