Provider Demographics
NPI:1952645749
Name:STEFFEN, RANDY LYNN (RRT RCP)
Entity Type:Individual
Prefix:
First Name:RANDY
Middle Name:LYNN
Last Name:STEFFEN
Suffix:
Gender:M
Credentials:RRT RCP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4806 SWAN LAKE ROAD
Mailing Address - Street 2:
Mailing Address - City:DULUTH
Mailing Address - State:MN
Mailing Address - Zip Code:55811-1532
Mailing Address - Country:US
Mailing Address - Phone:956-638-6028
Mailing Address - Fax:
Practice Address - Street 1:4806 SWAN LAKE RD
Practice Address - Street 2:
Practice Address - City:DULUTH
Practice Address - State:MN
Practice Address - Zip Code:55811-1532
Practice Address - Country:US
Practice Address - Phone:956-638-6028
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-11-16
Last Update Date:2012-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX74352225800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225800000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRecreation Therapist