MEDICARE: LESLIE A MILLER LICSW

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	LW61472576	WA
2	1041C0700X	Clinical Social Worker	4267C	AL

General Provider Information

NPI Number	:	1194363473
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LESLIE A MILLER LICSW

Provider Business Mailing Address
First Line	:	2168 QUAIL TRL
Second Line	:
City	:	VESTAVIA HILLS
State	:	AL
Zip	:	35216-3440
Country	:	US
Telephone Number	:	205-558-8515
Fax Number	:

Provider Business Practice Location Address
First Line	:	2168 QUAIL TRL
Second Line	:
City	:	VESTAVIA HILLS
State	:	AL
Zip	:	35216-3440
Country	:	US
Telephone Number	:	205-558-8515
Fax Number	:

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

Provider Enumeration Date	:	12/17/2019
Last Update Date	:	05/06/2025

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