Miranda May Behnke, LBSW

Primary specialty

Addiction (Substance Use Disorder) CounselorTaxonomy code 101YA0400X

License

18736-130 Issued in WI

Practice address

1409 Cleveland Ave
Marinette, WI 54143-3918

Phone

(715) 735-0095

Fax

(715) 735-0094

NPI assigned

Jul 12, 2006

Last updated

Nov 20, 2019By the provider in NPPES

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Addresses

Other identifiers 2

Other names 1

• Miranda May Shallow Former name

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1152662400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1574208000000",
    "number": "1508881772",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "715 PYLE DR",
            "city": "KINGSFORD",
            "state": "MI",
            "postal_code": "498024456",
            "telephone_number": "906-774-0522",
            "fax_number": "906-774-1570"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1409 CLEVELAND AVE",
            "city": "MARINETTE",
            "state": "WI",
            "postal_code": "541433918",
            "telephone_number": "715-735-0095",
            "fax_number": "715-735-0094"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BEHNKE",
        "first_name": "MIRANDA",
        "middle_name": "MAY",
        "credential": "LBSW",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-07-12",
        "last_updated": "2019-11-20",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YA0400X",
            "taxonomy_group": "",
            "desc": "Counselor, Addiction (Substance Use Disorder)",
            "state": "WI",
            "license": "18736-130",
            "primary": true
        },
        {
            "code": "104100000X",
            "taxonomy_group": "",
            "desc": "Social Worker",
            "state": "WI",
            "license": "9668-120",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PREFERRED ONE",
            "identifier": "982471046475",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS OF MI",
            "identifier": "MB085458",
            "state": "MI"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "MIRANDA",
            "last_name": "SHALLOW",
            "middle_name": "MAY",
            "credential": "LBSW",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

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• Bellin Psychiatric Center Inc (Bellin Psychiatric Center Marinette)

• Addiction (Substance Use Disorder) Counselor in Marinette, WI
• Providers in Marinette, WI by specialty
• Addiction (Substance Use Disorder) Counselor in Wisconsin

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 20, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.