| Doctor Name: | MRS. MIRANDA LYN MIDDONA |
| NPI Number: | 1619232154 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | LCSW |
| License Number: | 149015352 |
| Business Practice Address: | 913 Kindberg Court Elburn, IL - 60119 |
| Business Phone Number: | 6303654211 |
| Business Fax Number: | |
| Mailing Address: | 913 Kindberg Court, ELBURN |
| State: | IL |
| Postal Code: | 60119 |
| Phone Number: | 6303654211 |
| Fax Number: | |
| NPI Enumeration Date: | 07/11/2012 |
| NPI Last Update Date: | 07/11/2012 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 101YM0800X |
| License Number: | 149015352 |
| Healthcare Provider Taxonomy: (Secondary) | N |
| State: | IL |
| Taxonomy Type: | Behavioral Health & Social Service Providers |
| Taxonomy Classification: | Counselor |
| Taxonomy Specialization: | Mental Health |
| Taxonomy Definition: | |