Healthcare Provider Details

I. General information

NPI: 1780890418
Provider Name (Legal Business Name): JENNIFER LYNN MILLER
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/16/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7241 W ROSE GARDEN LN
GLENDALE AZ
85308-9634
US

IV. Provider business mailing address

8944 W HARMONY LN
PEORIA AZ
85382-2407
US

V. Phone/Fax

Practice location:
  • Phone: 623-376-4800
  • Fax: 623-376-4800
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YS0200X
TaxonomySchool Counselor
License Number1239803
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: