Provider Demographics
NPI:1548464357
Name:DUNCAN, MIRANDA RACHELLE (MS, CCCSLP)
Entity type:Individual
Prefix:
First Name:MIRANDA
Middle Name:RACHELLE
Last Name:DUNCAN
Suffix:
Gender:F
Credentials:MS, CCCSLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:RR 3 BOX 47
Mailing Address - Street 2:
Mailing Address - City:ALBION
Mailing Address - State:IL
Mailing Address - Zip Code:62806-9507
Mailing Address - Country:US
Mailing Address - Phone:618-446-5194
Mailing Address - Fax:
Practice Address - Street 1:RR 3 BOX 47
Practice Address - Street 2:
Practice Address - City:ALBION
Practice Address - State:IL
Practice Address - Zip Code:62806-9507
Practice Address - Country:US
Practice Address - Phone:618-446-5194
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist