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General NPI Number Information
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NPI Number | 1154093458
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Entity Type | Individual
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Provider Name | MADISON MILLER TLMFT
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Gender | Female
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Dates
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Enumeration Date | 10/04/2021
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Last Update Date | 10/04/2021
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Provider Practice Location Address
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Address Line | 1089 LONGFELLOW DR STE C
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City | HIAWATHA
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State | IA
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Zip | 52233-2023
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Country | US
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Telephone | 319-224-5997
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Fax |
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Provider Business Mailing Address
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Address Line | 12 AL WATERHOUSE AVE
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City | CENTRAL CITY
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State | IA
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Zip | 52214-9420
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Country | US
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Telephone | 319-929-8840
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 106H00000X
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Taxonomy Name | Marriage & Family Therapist
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License Number | 107655
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License Number State | IA
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