MEDICARE: SANDRA MILLER CDCA

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	101YA0400X	Addiction (Substance Use Disorder) Counselor	170572	OH

General Provider Information

NPI Number	:	1053942722
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SANDRA MILLER CDCA

Provider Business Mailing Address
First Line	:	2896 RED OAK DR
Second Line	:
City	:	PERRY
State	:	OH
Zip	:	44081-9400
Country	:	US
Telephone Number	:	440-796-6696
Fax Number	:

Provider Business Practice Location Address
First Line	:	2231 N TAYLOR RD
Second Line	:
City	:	CLEVELAND HEIGHTS
State	:	OH
Zip	:	44112-3044
Country	:	US
Telephone Number	:	440-796-6696
Fax Number	:

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

Provider Enumeration Date	:	01/30/2020
Last Update Date	:	01/30/2020

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