Healthcare Provider Details

I. General information

NPI: 1255570818
Provider Name (Legal Business Name): STACEYLEE MILLER
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/05/2009
Last Update Date: 02/05/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1243 SHED RD
BEDFORD PA
15522-8584
US

IV. Provider business mailing address

1243 SHED RD
BEDFORD PA
15522-8584
US

V. Phone/Fax

Practice location:
  • Phone: 814-623-5166
  • Fax: 814-623-3460
Mailing address:
  • Phone: 814-623-5166
  • Fax: 814-623-3460

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: