Provider Demographics
NPI:1902207293
Name:PRICHARD, MIRIAM
Entity Type:Individual
Prefix:
First Name:MIRIAM
Middle Name:
Last Name:PRICHARD
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1706 BRADY ST
Mailing Address - Street 2:SUITE 204
Mailing Address - City:DAVENPORT
Mailing Address - State:IA
Mailing Address - Zip Code:52803-4712
Mailing Address - Country:US
Mailing Address - Phone:563-265-4477
Mailing Address - Fax:
Practice Address - Street 1:1706 BRADY ST
Practice Address - Street 2:SUITE 204
Practice Address - City:DAVENPORT
Practice Address - State:IA
Practice Address - Zip Code:52803-4712
Practice Address - Country:US
Practice Address - Phone:563-265-4477
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-09-05
Last Update Date:2014-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health