=====================================================
General NPI Number Information
=====================================================
NPI Number | 1881216364
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | SARAH MACKESY MILLER LSW
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 05/07/2020
-----------------------------------------------------
Last Update Date | 02/25/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 8245 FARNSWORTH RD STE B
-----------------------------------------------------
City | WATERVILLE
-----------------------------------------------------
State | OH
-----------------------------------------------------
Zip | 43566-9478
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 419-276-3946
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 2021 PLEISCHER RD
-----------------------------------------------------
City | GROVER HILL
-----------------------------------------------------
State | OH
-----------------------------------------------------
Zip | 45849-9735
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 937-935-3431
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 1041C0700X
-----------------------------------------------------
Taxonomy Name | Clinical Social Worker
-----------------------------------------------------
License Number | S.1903658
-----------------------------------------------------
License Number State | OH
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 104100000X
-----------------------------------------------------
Taxonomy Name | Social Worker
-----------------------------------------------------
License Number | S.1903658
-----------------------------------------------------
License Number State | OH
-----------------------------------------------------