Healthcare Provider Details

I. General information

NPI: 1447477559
Provider Name (Legal Business Name): SUZANNE ROBERTSON MILLER M.A., CRC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/19/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6770 HEATHVIEW ST
WORTHINGTON OH
43085-2953
US

IV. Provider business mailing address

6770 HEATHVIEW ST
WORTHINGTON OH
43085-2953
US

V. Phone/Fax

Practice location:
  • Phone: 614-885-6108
  • Fax: 614-885-6109
Mailing address:
  • Phone: 614-885-6108
  • Fax: 614-885-6109

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225C00000X
TaxonomyRehabilitation Counselor
License NumberCRC #25680
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: