Provider Demographics
NPI:1215722723
Name:MOEN, CRYSTAL LEA
Entity type:Individual
Prefix:
First Name:CRYSTAL
Middle Name:LEA
Last Name:MOEN
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7550 FRANCE AVE S STE 200
Mailing Address - Street 2:
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55435-4788
Mailing Address - Country:US
Mailing Address - Phone:952-955-4057
Mailing Address - Fax:
Practice Address - Street 1:7550 FRANCE AVE S STE 200
Practice Address - Street 2:
Practice Address - City:MINNEAPOLIS
Practice Address - State:MN
Practice Address - Zip Code:55435-4788
Practice Address - Country:US
Practice Address - Phone:952-955-4057
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-04-14
Last Update Date:2025-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician