MEDICARE: JENNY LYNN MILLER LPC

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	101YP2500X	Professional Counselor	40051-125	WI

General Provider Information

NPI Number	:	1164683900
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JENNY LYNN MILLER LPC

Provider Business Mailing Address
First Line	:	8800 WASHINGTON AVE
Second Line	:	100
City	:	MOUNT PLEASANT
State	:	WI
Zip	:	53406-3701
Country	:	US
Telephone Number	:	262-633-3591
Fax Number	:	262-633-2619

Provider Business Practice Location Address
First Line	:	8800 WASHINGTON AVE
Second Line	:	100
City	:	MOUNT PLEASANT
State	:	WI
Zip	:	53406-3701
Country	:	US
Telephone Number	:	262-633-3591
Fax Number	:	262-633-2619

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

Provider Enumeration Date	:	06/24/2008
Last Update Date	:	08/06/2015

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