Individual
MIRANDA ELLEN RENEE KOLDE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MSW
Contact information
Practice address
909 E STATE BLVD, FORT WAYNE, IN 46805-3404
(260) 481-2700
(260) 481-2838
Mailing address
11109 PARKVIEW PLAZA DR # 117, FORT WAYNE, IN 46845-1701
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
34008801A
IN
Other
Enumeration date
11/13/2017
Last updated
12/06/2022
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