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General NPI Number Information
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NPI Number | 1457637779
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Entity Type | Individual
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Provider Name | MS. JENNA LEANNE MILLER
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Gender | Female
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Dates
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Enumeration Date | 11/01/2011
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Last Update Date | 03/15/2024
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Provider Practice Location Address
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Address Line | 500 MARQUETTE AVE NW STE 360
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City | ALBUQUERQUE
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State | NM
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Zip | 87102-5317
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Country | US
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Telephone | 505-557-4656
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Fax | 505-514-0874
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Provider Business Mailing Address
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Address Line | 3003 ADAMS ST NE APT K17
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City | ALBUQUERQUE
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State | NM
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Zip | 87110-8005
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Country | US
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Telephone | 575-640-1264
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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 | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | M-08047
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License Number State | NM
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