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General NPI Number Information
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NPI Number | 1700340965
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Entity Type | Individual
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Provider Name | STEVIE MILLER
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Gender | Female
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Dates
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Enumeration Date | 01/22/2019
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Last Update Date | 03/09/2019
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Provider Practice Location Address
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Address Line | 13105 W BLUEMOUND RD STE 100
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City | BROOKFIELD
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State | WI
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Zip | 53005-8046
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Country | US
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Telephone | 262-641-9790
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Fax |
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Provider Business Mailing Address
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Address Line | 11274 W TALON CIR
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City | GREENFIELD
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State | WI
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Zip | 53228-3142
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Country | US
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Telephone |
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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 | 673-228
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License Number State | WI
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