Healthcare Provider Details

I. General information

NPI: 1083262554
Provider Name (Legal Business Name): HAILEE M MILLER
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: HAILEE LIPINSKY

II. Dates (important events)

Enumeration Date: 08/28/2019
Last Update Date: 10/09/2026
Certification Date: 10/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2420 LAKE AVE
ASHTABULA OH
44004-4954
US

IV. Provider business mailing address

2420 LAKE AVE
ASHTABULA OH
44004-4954
US

V. Phone/Fax

Practice location:
  • Phone: 440-997-6693
  • Fax:
Mailing address:
  • Phone: 440-997-6693
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License NumberI-2607833
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: