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NPI Code Detail

MEDICARE: MIRANDA FERGUSON

MEDICARE: MIRANDA FERGUSON
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
1106S00000XBehavior TechnicianRBT-25-496374IN

General Provider Information

NPI Number : 1679436786
Entity Type Code : Individual
Provider Name (Legal Business Name) : MIRANDA FERGUSON
Provider Business Mailing Address
First Line : 1827 E IRELAND RD
Second Line :
City : SOUTH BEND
State : IN
Zip : 46614-2845
Country : US
Telephone Number : 574-387-4313
Fax Number :
Provider Business Practice Location Address
First Line : 3435 W 96TH ST
Second Line :
City : INDIANAPOLIS
State : IN
Zip : 46268-1102
Country : US
Telephone Number : 574-387-4313
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 12/05/2025
Last Update Date : 12/05/2025

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Directions to “ MIRANDA FERGUSON ” Practice Location

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These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.

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