MEDICARE: MIRANDA KARGOL LPC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YM0800X	Mental Health Counselor	11730-125	WI
2	101YP2500X	Professional Counselor	11730	WI

General Provider Information

NPI Number	:	1487335766
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MIRANDA KARGOL LPC

Provider Business Mailing Address
First Line	:	1827 E WASHINGTON AVE
Second Line	:
City	:	MADISON
State	:	WI
Zip	:	53704-5240
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1943 WINNEBAGO ST
Second Line	:
City	:	MADISON
State	:	WI
Zip	:	53704-5314
Country	:	US
Telephone Number	:	999-999-9999
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/28/2023
Last Update Date	:	12/15/2025

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Directions to “ MIRANDA KARGOL LPC” Practice Location

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