1013318823 NPI number — MIRANDA SCHUNK MA, LPCC

Table of content: MIRANDA SCHUNK MA, LPCC (NPI 1013318823)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1013318823 NPI number — MIRANDA SCHUNK MA, LPCC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
SCHUNK
Provider First Name:
MIRANDA
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
MA, LPCC
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1013318823
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
09/11/2014
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
41385 US HIGHWAY 71, PO BOX 353
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
WINDOM
Provider Business Mailing Address State Name:
MN
Provider Business Mailing Address Postal Code:
56101-3197
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
507-831-2090
Provider Business Mailing Address Fax Number:
507-831-0185

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
41385 US HIGHWAY 71
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
WINDOM
Provider Business Practice Location Address State Name:
MN
Provider Business Practice Location Address Postal Code:
56101-3197
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
507-831-2090
Provider Business Practice Location Address Fax Number:
507-831-0185
Provider Enumeration Date:
09/11/2014

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 101YM0800X , with the licence number:  CC00839 , registered in the state of MN ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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