Healthcare Provider Details

I. General information

NPI: 1760093934
Provider Name (Legal Business Name): CAITLIN RUBY MILLER LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/12/2020
Last Update Date: 10/07/2026
Certification Date: 10/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1340 SHERMER RD STE 280
NORTHBROOK IL
60062-4589
US

IV. Provider business mailing address

203 MELODY LN
VERONA WI
53593-1427
US

V. Phone/Fax

Practice location:
  • Phone: 608-284-0524
  • Fax:
Mailing address:
  • Phone: 608-284-0524
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number178.015560
License Number StateIL
# 2
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number11799-125
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: