Provider Demographics
NPI:1568469104
Name:BINGNER, STEVEN (MS, LP)
Entity Type:Individual
Prefix:
First Name:STEVEN
Middle Name:
Last Name:BINGNER
Suffix:
Gender:M
Credentials:MS, LP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3640 9TH ST NW
Mailing Address - Street 2:
Mailing Address - City:ROCHESTER
Mailing Address - State:MN
Mailing Address - Zip Code:55901-6685
Mailing Address - Country:US
Mailing Address - Phone:507-424-3234
Mailing Address - Fax:507-424-3235
Practice Address - Street 1:3640 9TH ST NW
Practice Address - Street 2:
Practice Address - City:ROCHESTER
Practice Address - State:MN
Practice Address - Zip Code:55901-6685
Practice Address - Country:US
Practice Address - Phone:507-424-3234
Practice Address - Fax:507-424-3235
Is Sole Proprietor?:No
Enumeration Date:2005-06-28
Last Update Date:2019-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN0911103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN29A94BIOtherBC/BS
MN4143482500Medicaid