Healthcare Provider Details

I. General information

NPI: 1609010263
Provider Name (Legal Business Name): SCOTT EDWARD MILLER
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/27/2009
Last Update Date: 09/10/2026
Certification Date: 09/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10260 SW GREENBURG RD # 4
PORTLAND OR
97223-5500
US

IV. Provider business mailing address

10260 SW GREENBURG RD # 4
PORTLAND OR
97223-5500
US

V. Phone/Fax

Practice location:
  • Phone: 833-940-1385
  • Fax:
Mailing address:
  • Phone: 833-940-1385
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberL6282
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: