Healthcare Provider Details

I. General information

NPI: 1184420275
Provider Name (Legal Business Name): TAYLOR LYNN MILLER
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/20/2025
Last Update Date: 02/20/2025
Certification Date: 02/17/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5232 KYLER AVE NE STE C
ALBERTVILLE MN
55301-4775
US

IV. Provider business mailing address

5232 KYLER AVE NE
ALBERTVILLE MN
55301-4774
US

V. Phone/Fax

Practice location:
  • Phone: 763-260-5313
  • Fax:
Mailing address:
  • Phone: 763-260-5313
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number4579
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: