Individual
CHERYL MIRACLE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LCSW
Contact information
Practice address
3409 S 200 W, KOKOMO, IN 46902-9613
(260) 563-8453
Mailing address
3563 S STATE ROAD 13, WABASH, IN 46992-9162
(260) 563-8453
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
34005876A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000671582
BLUE CROSS BLUE SHIELD
IN
01
—
000542210
UNITED BEHAVIORAL HEALTH
IN
05
—
201097990
—
IN
01
—
600642605
MAGELLAN
IN
01
—
9478593
AETNA
IN
Enumeration date
01/25/2008
Last updated
01/13/2015
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