Provider Demographics
NPI:1790076982
Name:MOE, MIRANDA MICHELLE (MSW)
Entity type:Individual
Prefix:MRS
First Name:MIRANDA
Middle Name:MICHELLE
Last Name:MOE
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2900 E GRAND AVE UNIT 13
Mailing Address - Street 2:
Mailing Address - City:LARAMIE
Mailing Address - State:WY
Mailing Address - Zip Code:82070-5268
Mailing Address - Country:US
Mailing Address - Phone:970-231-9171
Mailing Address - Fax:
Practice Address - Street 1:2900 E GRAND AVE UNIT 13
Practice Address - Street 2:
Practice Address - City:LARAMIE
Practice Address - State:WY
Practice Address - Zip Code:82070-5268
Practice Address - Country:US
Practice Address - Phone:970-231-9171
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-04-22
Last Update Date:2024-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker