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General NPI Number Information
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NPI Number | 1972007474
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Entity Type | Individual
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Provider Name | MIRANDA ANN PEYTON LISW, MT-BC
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Gender | Female
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Dates
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Enumeration Date | 03/20/2018
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Last Update Date | 09/13/2025
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Provider Practice Location Address
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Address Line | 360 7TH AVE STE 4B
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City | MARION
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State | IA
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Zip | 52302-5771
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Country | US
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Telephone | 319-382-0739
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Fax |
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Provider Business Mailing Address
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Address Line | 1655 BLAIRS FERRY RD
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City | MARION
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State | IA
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Zip | 52302-3157
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Country | US
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Telephone |
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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 | 095554
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License Number State | IA
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Taxonomy #2
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Taxonomy Code | 225A00000X
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Taxonomy Name | Music Therapist
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License Number | 12184
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License Number State | IA
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