Healthcare Provider Details

I. General information

NPI: 1598381857
Provider Name (Legal Business Name): ASHLEY MARIE MILLER LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/23/2020
Last Update Date: 03/12/2024
Certification Date: 03/08/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5455 DAISY STREET
TILLAMOOK OR
97141
US

IV. Provider business mailing address

PO BOX 361
OCEANSIDE OR
97134-0361
US

V. Phone/Fax

Practice location:
  • Phone: 503-664-0168
  • Fax:
Mailing address:
  • Phone: 971-727-6488
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberL11493
License Number StateOR

VII. Legacy identifiers

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

# 1
IdentifierL11493
Identifier TypeOTHER
Identifier StateOR
Identifier IssuerLCSW (LICENSED CLINICAL SOCIAL WORKER) LICENSE NUMBER

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: