Provider Demographics
NPI:1871620500
Name:MIRANDA, LENORE M (SLP)
Entity type:Individual
Prefix:
First Name:LENORE
Middle Name:M
Last Name:MIRANDA
Suffix:
Gender:F
Credentials:SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:18551 E 160TH AVE
Mailing Address - Street 2:
Mailing Address - City:BRIGHTON
Mailing Address - State:CO
Mailing Address - Zip Code:80601-8519
Mailing Address - Country:US
Mailing Address - Phone:303-655-2920
Mailing Address - Fax:
Practice Address - Street 1:18551 E 160TH AVE
Practice Address - Street 2:
Practice Address - City:BRIGHTON
Practice Address - State:CO
Practice Address - Zip Code:80601-8519
Practice Address - Country:US
Practice Address - Phone:303-655-2900
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-28
Last Update Date:2024-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NMJ 3513Medicaid