Healthcare Provider Details

I. General information

NPI: 1891741070
Provider Name (Legal Business Name): CINDY L. MILLER LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/26/2006
Last Update Date: 11/19/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1341 WARREN AVE
DOWNERS GROVE IL
60515-3437
US

IV. Provider business mailing address

1341 WARREN AVE
DOWNERS GROVE IL
60515-3437
US

V. Phone/Fax

Practice location:
  • Phone: 630-719-5454
  • Fax: 630-719-1263
Mailing address:
  • Phone: 630-719-5454
  • Fax: 630-719-1263

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number149.011778
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: