Provider Demographics
NPI:1740948165
Name:MORALES, MIRANDA NIKOLE
Entity type:Individual
Prefix:
First Name:MIRANDA
Middle Name:NIKOLE
Last Name:MORALES
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 1:1207 MORGAN ST
Mailing Address - Street 2:
Mailing Address - City:JOLIET
Mailing Address - State:IL
Mailing Address - Zip Code:60436-1440
Mailing Address - Country:US
Mailing Address - Phone:815-474-5398
Mailing Address - Fax:
Practice Address - Street 1:1207 MORGAN ST
Practice Address - Street 2:
Practice Address - City:JOLIET
Practice Address - State:IL
Practice Address - Zip Code:60436-1440
Practice Address - Country:US
Practice Address - Phone:815-474-5398
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-12-02
Last Update Date:2021-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TS0200XBehavioral Health & Social Service ProvidersPsychologistSchool