MEDICARE: JAN M MILLER LCSW

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	104100000X	Social Worker	2269-123	WI

General Provider Information

NPI Number	:	1083627665
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JAN M MILLER LCSW

Provider Business Mailing Address
First Line	:	440 SCIENCE DR STE 200
Second Line	:
City	:	MADISON
State	:	WI
Zip	:	53711-1064
Country	:	US
Telephone Number	:	608-238-5176
Fax Number	:	608-238-2727

Provider Business Practice Location Address
First Line	:	440 SCIENCE DR STE 200
Second Line	:
City	:	MADISON
State	:	WI
Zip	:	53711-1064
Country	:	US
Telephone Number	:	608-238-5176
Fax Number	:	608-238-2727

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/14/2006
Last Update Date	:	04/23/2009

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