Healthcare Provider Details

I. General information

NPI: 1699682963
Provider Name (Legal Business Name): JOBY M MILLER MSW, LSW, RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/25/2026
Last Update Date: 08/25/2026
Certification Date: 08/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1450 N COUNTY ROAD 2050 E
CARTHAGE IL
62321-3551
US

IV. Provider business mailing address

1 HICKORY GRV
MACOMB IL
61455-1108
US

V. Phone/Fax

Practice location:
  • Phone: 217-357-6888
  • Fax: 217-357-6889
Mailing address:
  • Phone: 217-357-6888
  • Fax: 217-357-6889

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number041.378720
License Number StateIL
# 3
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number150.131206
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: