Provider Demographics
NPI:1487338117
Name:AULIE, MIRANDA (LICSW)
Entity type:Individual
Prefix:
First Name:MIRANDA
Middle Name:
Last Name:AULIE
Suffix:
Gender:F
Credentials:LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4682 WILDERNESS CT # 103
Mailing Address - Street 2:
Mailing Address - City:BRAINERD
Mailing Address - State:MN
Mailing Address - Zip Code:56401-2834
Mailing Address - Country:US
Mailing Address - Phone:218-820-7671
Mailing Address - Fax:218-600-5500
Practice Address - Street 1:4682 WILDERNESS CT # 103
Practice Address - Street 2:
Practice Address - City:BRAINERD
Practice Address - State:MN
Practice Address - Zip Code:56401-2834
Practice Address - Country:US
Practice Address - Phone:218-820-7671
Practice Address - Fax:218-600-5500
Is Sole Proprietor?:Yes
Enumeration Date:2023-06-13
Last Update Date:2023-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN261961041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical