Provider Demographics
NPI:1164198180
Name:SLOAN, MIRANDA KATHRYN (LLBSW)
Entity Type:Individual
Prefix:
First Name:MIRANDA
Middle Name:KATHRYN
Last Name:SLOAN
Suffix:
Gender:F
Credentials:LLBSW
Other - Prefix:
Other - First Name:MIRANDA
Other - Middle Name:KATHRYN
Other - Last Name:GEDMIN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:LLBSW
Mailing Address - Street 1:6770 DIXIE HWY STE 200
Mailing Address - Street 2:
Mailing Address - City:CLARKSTON
Mailing Address - State:MI
Mailing Address - Zip Code:48346-5113
Mailing Address - Country:US
Mailing Address - Phone:248-276-8000
Mailing Address - Fax:248-276-9280
Practice Address - Street 1:6770 DIXIE HWY STE 200
Practice Address - Street 2:
Practice Address - City:CLARKSTON
Practice Address - State:MI
Practice Address - Zip Code:48346-5113
Practice Address - Country:US
Practice Address - Phone:248-276-8000
Practice Address - Fax:248-276-9280
Is Sole Proprietor?:No
Enumeration Date:2021-08-19
Last Update Date:2021-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6852090954104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker