Individual
KADIAN SAMANTHA MIRACLE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
100 WEST COLLEGE STREET, WHISLER HALL, GRANVILLE, OH 43023
(740) 274-5792
Mailing address
5806 WARNER MEADOWS DR, WESTERVILLE, OH 43081-8694
(740) 274-5792
Taxonomy
Speciality
Code
Description
License number
State
103TC0700X
Clinical Psychologist
Primary
P.7565
OH
103TH0100X
Health Service Psychologist
P.7565
OH
Other
Enumeration date
05/10/2019
Last updated
05/10/2019
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