MEDICARE: PAMELA MILLER

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	1041S0200X	School Social Worker

General Provider Information

NPI Number	:	1194193011
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	PAMELA MILLER

Provider Business Mailing Address
First Line	:	1615 CHALMERS DR
Second Line	:
City	:	CHESTERFIELD
State	:	MO
Zip	:	63017-5614
Country	:	US
Telephone Number	:	314-914-9942
Fax Number	:

Provider Business Practice Location Address
First Line	:	8309 MACKENZIE RD
Second Line	:
City	:	SAINT LOUIS
State	:	MO
Zip	:	63123-3455
Country	:	US
Telephone Number	:	314-914-9942
Fax Number	:

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

Provider Enumeration Date	:	09/09/2015
Last Update Date	:	09/09/2015

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Directions to “ PAMELA MILLER ” Practice Location

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