Healthcare Provider Details

I. General information

NPI: 1922759810
Provider Name (Legal Business Name): JEREMY R MILLER MSW, CBT, LSWAIC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/12/2022
Last Update Date: 04/02/2024
Certification Date: 04/02/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2400 NE 95TH ST
SEATTLE WA
98115-2426
US

IV. Provider business mailing address

11500 PINEHURST WAY NE APT 205
SEATTLE WA
98125-6342
US

V. Phone/Fax

Practice location:
  • Phone: 206-525-5050
  • Fax:
Mailing address:
  • Phone: 206-518-4028
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License NumberSC61542752
License Number StateWA
# 2
Primary TaxonomyN
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License NumberCB61252551
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: