Healthcare Provider Details

I. General information

NPI: 1093590614
Provider Name (Legal Business Name): SAM MILLER
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/30/2023
Last Update Date: 09/23/2026
Certification Date: 09/23/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

17951 JEFFERSON PARK RD STE 100
MIDDLEBURG HEIGHTS OH
44130-8439
US

IV. Provider business mailing address

21430 LORAIN RD STE 400
FAIRVIEW PARK OH
44126-2148
US

V. Phone/Fax

Practice location:
  • Phone: 440-879-8517
  • Fax: 440-445-8439
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: