Provider Demographics
NPI:1689344137
Name:PRAHL, MIRANDA (LICSW)
Entity Type:Individual
Prefix:
First Name:MIRANDA
Middle Name:
Last Name:PRAHL
Suffix:
Gender:F
Credentials:LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:401 HARDING ST NE # 100
Mailing Address - Street 2:
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55413-2801
Mailing Address - Country:US
Mailing Address - Phone:612-398-7000
Mailing Address - Fax:
Practice Address - Street 1:401 HARDING ST NE STE 100
Practice Address - Street 2:
Practice Address - City:MINNEAPOLIS
Practice Address - State:MN
Practice Address - Zip Code:55413-2801
Practice Address - Country:US
Practice Address - Phone:612-398-7000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-09-16
Last Update Date:2021-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN206181041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical