Healthcare Provider Details

I. General information

NPI: 1538641220
Provider Name (Legal Business Name): MRS. JESSICA MILLER
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/30/2018
Last Update Date: 08/01/2023
Certification Date: 08/01/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3471 E GRAND RIVER AVE
HOWELL MI
48843-8552
US

IV. Provider business mailing address

3471 E GRAND RAPIDS AVE
HOWELL MI
48843
US

V. Phone/Fax

Practice location:
  • Phone: 734-309-8198
  • Fax:
Mailing address:
  • Phone: 800-789-3062
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code247200000X
TaxonomyOther Technician
License Number
License Number StateMI
# 3
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: