Healthcare Provider Details

I. General information

NPI: 1629980164
Provider Name (Legal Business Name): TARA L MILLER
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/21/2026
Last Update Date: 09/21/2026
Certification Date: 09/20/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6302 ODANA RD
MADISON WI
53719-1162
US

IV. Provider business mailing address

2649 KOSHKONONG WAY
SUN PRAIRIE WI
53590-7061
US

V. Phone/Fax

Practice location:
  • Phone: 608-219-0992
  • Fax:
Mailing address:
  • Phone: 608-219-0992
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number135901121
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: