Miranda Wilson

NPI 1558963082 · on the registry since 2020

Practice

Address: 600 3 Mile Road Nw Suite 200
Grand Rapids, MI 49544
Phone: (616) 469-3870
Organisation at this address: Vicki Poleni Lmsw
Sarah Lickiss Lmsw Plc
Stacey Vanderklok, Llc
Building Blocks Therapy Services, Llc
Inferred from a shared address, not stated in the registry.
Clinicians at this address: 126

Registry record

Primary taxonomy: 103K00000X
103K00000X
Also registered as: 101YM0800X
106S00000X
Licence states on file: MI
From the registry's licence fields, which are often incomplete.
Sex: Female
Record last updated: 2025-10-06

Source: CMS National Plan and Provider Enumeration System. Registration is not the same as practising, and the registry records no retirement — some people listed here no longer practise. More in Michigan