Healthcare Provider Details

I. General information

NPI: 1215547278
Provider Name (Legal Business Name): MADELINE MILLER
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/05/2020
Last Update Date: 07/28/2025
Certification Date: 07/28/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4222 S FLORIDA AVE
LAKELAND FL
33813-1628
US

IV. Provider business mailing address

2130 MORGAN WIELAND LN APT 15-107
LAKELAND FL
33813-3195
US

V. Phone/Fax

Practice location:
  • Phone: 836-456-7148
  • Fax:
Mailing address:
  • Phone: 800-686-5614
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number1-25-82969
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code106E00000X
TaxonomyAssistant Behavior Analyst
License Number
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: