Provider Demographics
NPI:1528452059
Name:MIRANDA, LASHONDA (APSW, LCSW)
Entity type:Individual
Prefix:
First Name:LASHONDA
Middle Name:
Last Name:MIRANDA
Suffix:
Gender:F
Credentials:APSW, LCSW
Other - Prefix:
Other - First Name:LASHONDA
Other - Middle Name:
Other - Last Name:JOHNSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MSW
Mailing Address - Street 1:2555 N DR MARTIN LUTHER KING JR DR
Mailing Address - Street 2:
Mailing Address - City:MILWAUKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53212-2709
Mailing Address - Country:US
Mailing Address - Phone:414-372-8080
Mailing Address - Fax:
Practice Address - Street 1:2555 N DR MARTIN LUTHER KING JR DR
Practice Address - Street 2:
Practice Address - City:MILWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53212-2709
Practice Address - Country:US
Practice Address - Phone:414-372-8080
Practice Address - Fax:414-267-8570
Is Sole Proprietor?:No
Enumeration Date:2015-03-23
Last Update Date:2025-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI9847-123101YP2500X, 1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI100055505Medicaid