MEDICARE: RHONDA JOVETTE MILLER LMSW

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1041C0700X	Clinical Social Worker	6801070834	MI

General Provider Information

NPI Number	:	1053556662
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	RHONDA JOVETTE MILLER LMSW

Provider Business Mailing Address
First Line	:	16249 EASTWIND ST
Second Line	:
City	:	ROMULUS
State	:	MI
Zip	:	48174-3180
Country	:	US
Telephone Number	:	313-467-7215
Fax Number	:

Provider Business Practice Location Address
First Line	:	19304 GRAND RIVER AVE
Second Line	:
City	:	DETROIT
State	:	MI
Zip	:	48223-1202
Country	:	US
Telephone Number	:	313-467-3918
Fax Number	:	734-442-7054

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/10/2008
Last Update Date	:	02/06/2018

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