Healthcare Provider Details

I. General information

NPI: 1780519520
Provider Name (Legal Business Name): EMILY ALICIA MILLER
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/15/2026
Last Update Date: 06/15/2026
Certification Date: 06/15/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4545 S 86TH ST STE 100
LINCOLN NE
68526-9263
US

IV. Provider business mailing address

515 W WASHINGTON ST
MARENGO IL
60152-2155
US

V. Phone/Fax

Practice location:
  • Phone: 402-483-6990
  • Fax:
Mailing address:
  • Phone: 815-575-6622
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number
License Number StateNE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: