MEDICARE: JESIKA MOXLEY MILLER

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	103K00000X	Behavior Analyst

General Provider Information

NPI Number	:	1871940049
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JESIKA MOXLEY MILLER

Provider Business Mailing Address
First Line	:	2201 S 19TH ST STE 206
Second Line	:
City	:	TACOMA
State	:	WA
Zip	:	98405-2961
Country	:	US
Telephone Number	:	253-312-3598
Fax Number	:

Provider Business Practice Location Address
First Line	:	9307 N LAKE DR SW STE 110
Second Line	:
City	:	LAKEWOOD
State	:	WA
Zip	:	98498-1135
Country	:	US
Telephone Number	:	253-370-8173
Fax Number	:

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

Provider Enumeration Date	:	05/18/2016
Last Update Date	:	10/19/2022

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