Healthcare Provider Details

I. General information

NPI: 1194369538
Provider Name (Legal Business Name): HEIDI MILLER MA, TLMFT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/29/2019
Last Update Date: 09/13/2023
Certification Date: 09/13/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4403 1ST AVE SE STE 505
CEDAR RAPIDS IA
52402-3222
US

IV. Provider business mailing address

4403 1ST AVE SE STE 505
CEDAR RAPIDS IA
52402-3222
US

V. Phone/Fax

Practice location:
  • Phone: 319-214-0870
  • Fax:
Mailing address:
  • Phone: 319-214-0870
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number119898
License Number StateIA
# 2
Primary TaxonomyN
Taxonomy Code174H00000X
TaxonomyHealth Educator
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: