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General NPI Number Information
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NPI Number | 1538075072
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Entity Type | Individual
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Provider Name | MIRANDA JO WAYNE APSW
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Gender | Female
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Dates
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Enumeration Date | 08/24/2026
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Last Update Date | 08/27/2026
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Provider Practice Location Address
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Address Line | 900 CREST VIEW DR STE 120
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City | HUDSON
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State | WI
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Zip | 54016-9517
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Country | US
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Telephone | 715-716-4371
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Fax |
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Provider Business Mailing Address
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Address Line | 664 TRADITION TRL
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City | RIVER FALLS
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State | WI
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Zip | 54022-8302
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Country | US
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Telephone | 715-556-5523
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 104100000X
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Taxonomy Name | Social Worker
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License Number | 136281-121
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License Number State | WI
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