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General NPI Number Information
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NPI Number | 1982322533
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Entity Type | Individual
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Provider Name | MIRANDA RAWLEY BS, LADC
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Gender | Female
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Dates
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Enumeration Date | 08/19/2022
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Last Update Date | 08/19/2022
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Provider Practice Location Address
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Address Line | 1906 5TH AVE SE
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City | LITTLE FALLS
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State | MN
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Zip | 56345-3317
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Country | US
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Telephone | 320-761-1142
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Fax |
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Provider Business Mailing Address
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Address Line | 1906 5TH AVE SE
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City | LITTLE FALLS
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State | MN
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Zip | 56345-3317
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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 | 101YA0400X
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Taxonomy Name | Addiction (Substance Use Disorder) Counselor
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License Number | 306451
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License Number State | MN
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