Provider Demographics
NPI:1972007474
Name:PEYTON, MIRANDA ANN (LMSW MT-BC)
Entity Type:Individual
Prefix:
First Name:MIRANDA
Middle Name:ANN
Last Name:PEYTON
Suffix:
Gender:F
Credentials:LMSW MT-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1655 BLAIRS FERRY RD
Mailing Address - Street 2:
Mailing Address - City:MARION
Mailing Address - State:IA
Mailing Address - Zip Code:52302-3157
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1655 BLAIRS FERRY RD
Practice Address - Street 2:
Practice Address - City:MARION
Practice Address - State:IA
Practice Address - Zip Code:52302-3157
Practice Address - Country:US
Practice Address - Phone:319-261-2292
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-03-20
Last Update Date:2019-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA12184225A00000X
IA09554104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
No225A00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMusic Therapist