Healthcare Provider Details

I. General information

NPI: 1861813164
Provider Name (Legal Business Name): AARON MILLER SW, CSAC
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/04/2014
Last Update Date: 08/15/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

199 HOME RD
JUNEAU WI
53039-1401
US

IV. Provider business mailing address

N4490 COUNTY RD E
HUSTISFORD WI
53034-9731
US

V. Phone/Fax

Practice location:
  • Phone: 920-386-4094
  • Fax: 920-386-3812
Mailing address:
  • Phone: 262-825-8445
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code104100000X
TaxonomySocial Worker
License Number12024-120
License Number StateWI
# 2
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number16045-132
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: