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General NPI Number Information
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NPI Number | 1750207536
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Entity Type | Individual
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Provider Name | LAURA GRADISHAR MILLER MSCP
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Gender | Female
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Dates
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Enumeration Date | 06/26/2026
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Last Update Date | 06/26/2026
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Provider Practice Location Address
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Address Line | 920 SOUTH PRAIRIE, UNIT G
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City | SYCAMORE
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State | IN
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Zip | 60178
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Country | US
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Telephone | 779-269-4065
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Fax |
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Provider Business Mailing Address
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Address Line | 4720 LACEY AVE
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City | LISLE
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State | IL
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Zip | 60532-1891
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Country | US
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Telephone | 818-782-2211
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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 | 106S00000X
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Taxonomy Name | Behavior Technician
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License Number | 1588395362
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License Number State | IL
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