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General NPI Number Information
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NPI Number | 1972011963
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Entity Type | Individual
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Provider Name | JORDAN NOELLE MILLER
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Gender | Female
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Dates
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Enumeration Date | 01/12/2018
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Last Update Date | 01/12/2018
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Provider Practice Location Address
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Address Line | 3220 DEMING WAY
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City | MIDDLETON
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State | WI
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Zip | 53562-1498
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Country | US
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Telephone | 608-830-6545
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Fax |
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Provider Business Mailing Address
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Address Line | 3220 DEMING WAY
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City | MIDDLETON
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State | WI
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Zip | 53562-1498
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Country | US
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Telephone | 608-830-6545
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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 | 104100000X
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Taxonomy Name | Social Worker
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License Number | 128441-121
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License Number State | WI
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