Healthcare Provider Details

I. General information

NPI: 1871175729
Provider Name (Legal Business Name): CIERA MILES LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: CIERA DONHAM

II. Dates (important events)

Enumeration Date: 04/21/2021
Last Update Date: 07/27/2021
Certification Date: 07/27/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

721 W 13TH ST STE 121
JASPER IN
47546-1856
US

IV. Provider business mailing address

PO BOX 1028
JASPER IN
47547-1028
US

V. Phone/Fax

Practice location:
  • Phone: 812-996-5780
  • Fax: 812-996-5784
Mailing address:
  • Phone: 812-996-8478
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number34009388A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: