Individual
MIRANDA DEPOY
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
2314 MIAMI ST, SOUTH BEND, IN 46614-1336
(574) 329-6856
Mailing address
642 W 500 S, ROCHESTER, IN 46975-8135
Taxonomy
Speciality
Code
Description
License number
State
103K00000X
Behavior Analyst
Primary
0-15-6738
IN
Other
Enumeration date
01/13/2016
Last updated
01/13/2016
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