Provider Demographics
NPI:1740227776
Name:MONGEON, STEVEN J (PT)
Entity Type:Individual
Prefix:
First Name:STEVEN
Middle Name:J
Last Name:MONGEON
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:101 MISSION VIEW PL
Mailing Address - Street 2:
Mailing Address - City:CASHMERE
Mailing Address - State:WA
Mailing Address - Zip Code:98815-9619
Mailing Address - Country:US
Mailing Address - Phone:509-884-5719
Mailing Address - Fax:
Practice Address - Street 1:117 S. CHELAN ST.
Practice Address - Street 2:
Practice Address - City:WATERVILLE
Practice Address - State:WA
Practice Address - Zip Code:98858
Practice Address - Country:US
Practice Address - Phone:509-745-8447
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-31
Last Update Date:2016-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPT00006840174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WAAB10637Medicare ID - Type UnspecifiedMEDI. IND. #