Individual
MIRANDA RENEE ILLIUS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
BCBA
Contact information
Practice address
38530 CHESTER RD STE 100, AVON, OH 44011-4048
(216) 282-1234
Mailing address
27991 CENTER RIDGE RD, WESTLAKE, OH 44145-3902
(440) 455-3230
Taxonomy
Speciality
Code
Description
License number
State
103K00000X
Behavior Analyst
Primary
1-18-30479
OH
Other
Enumeration date
06/26/2018
Last updated
11/21/2022
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