MEDICARE: BROOKE MARIE MILLER MA, R-DMT

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	225600000X	Dance Therapist	2399	WI
2	101YM0800X	Mental Health Counselor	10789-125	WI

General Provider Information

NPI Number	:	1821695172
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	BROOKE MARIE MILLER MA, R-DMT

Provider Business Mailing Address
First Line	:	3202 N 52ND ST
Second Line	:
City	:	MILWAUKEE
State	:	WI
Zip	:	53216-3242
Country	:	US
Telephone Number	:	715-892-2852
Fax Number	:

Provider Business Practice Location Address
First Line	:	700 W VIRGINIA ST STE 204
Second Line	:
City	:	MILWAUKEE
State	:	WI
Zip	:	53204-1549
Country	:	US
Telephone Number	:	414-207-4565
Fax Number	:	414-348-0206

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

Provider Enumeration Date	:	10/08/2020
Last Update Date	:	10/03/2024

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