Provider Demographics
NPI:1326244229
Name:KUENDIG, MIRAN W (PHD)
Entity Type:Individual
Prefix:DR
First Name:MIRAN
Middle Name:W
Last Name:KUENDIG
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:100 30TH ST. NW
Mailing Address - Street 2:SUITE 109
Mailing Address - City:CANTON
Mailing Address - State:OH
Mailing Address - Zip Code:44709
Mailing Address - Country:US
Mailing Address - Phone:330-492-5272
Mailing Address - Fax:330-491-0000
Practice Address - Street 1:100 30TH ST. NW
Practice Address - Street 2:SUITE 109
Practice Address - City:CANTON
Practice Address - State:OH
Practice Address - Zip Code:44709
Practice Address - Country:US
Practice Address - Phone:330-492-5272
Practice Address - Fax:330-491-0000
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH6066103G00000X, 103T00000X, 103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Not Answered103G00000XBehavioral Health & Social Service ProvidersClinical NeuropsychologistGroup - Multi-Specialty
Not Answered103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Multi-Specialty
Not Answered103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Multi-Specialty