Active NPI
Miranda Venosdle
- Health Service Psychologist
- Minerva, OH
National Provider Identifier
1790521037
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Health Service Psychologist
- License
- TX686038
- Practice address
- 14000 Lincoln St SE Lot 12
Minerva, OH 44657-8948 - Phone
- (740) 291-0110
- NPI assigned
- Jul 5, 2024
- Last updated
- Jun 28, 2025
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Health Service Psychologist | 103TH0100X | TX686038 | OH | Primary |
Addresses
Primary practice location
14000 Lincoln St SE Lot 12
Minerva, OH 44657-8948
Mailing address
14000 Lincoln St SE Lot 12
Minerva, OH 44657-8948
Phone (234) 427-9031
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| TX686038 | OH | MD | Health Service Psychologist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1720137600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1751068800000",
"number": "1790521037",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "14000 LINCOLN ST SE LOT 12",
"city": "MINERVA",
"state": "OH",
"postal_code": "446578948",
"telephone_number": "234-427-9031"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "14000 LINCOLN ST SE LOT 12",
"city": "MINERVA",
"state": "OH",
"postal_code": "446578948",
"telephone_number": "740-291-0110"
}
],
"practiceLocations": [],
"basic": {
"last_name": "VENOSDLE",
"first_name": "MIRANDA",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2024-07-05",
"last_updated": "2025-06-28",
"certification_date": "2025-06-28",
"status": "A"
},
"taxonomies": [
{
"code": "103TH0100X",
"taxonomy_group": "",
"desc": "Psychologist, Health Service",
"state": "OH",
"license": "TX686038",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Minerva, OH
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 28, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.