Healthcare Provider Details

I. General information

NPI: 1255818365
Provider Name (Legal Business Name): MEGAN R MILLER LISW-S
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: MEGAN RACHAEL LEE LISW-S

II. Dates (important events)

Enumeration Date: 07/20/2018
Last Update Date: 02/02/2024
Certification Date: 02/02/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

329 N WEST ST
LIMA OH
45801-4331
US

IV. Provider business mailing address

329 N WEST ST
LIMA OH
45801-4331
US

V. Phone/Fax

Practice location:
  • Phone: 419-221-3072
  • Fax: 419-481-9865
Mailing address:
  • Phone: 419-221-3072
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberI.2103137-SUPV
License Number StateOH
# 2
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License NumberI.2103137-SUPV
License Number StateOH

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: