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NPI Code Detail

MEDICARE: DIANNE LADON PHILLIPS-MILLER PH.D.

MEDICARE: DIANNE LADON PHILLIPS-MILLER PH.D.
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
1103TC1900XCounseling PsychologistPSY 288ID

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1P9205OTHERIDAPS HEALTHCARE
2N4460OTHERIDBLUE CROSS OF IDAHO
3CBH2228116OTHERIDCIGNA

General Provider Information

NPI Number : 1336106830
Entity Type Code : Individual
Provider Name (Legal Business Name) : DIANNE LADON PHILLIPS-MILLER PH.D.
Provider Business Mailing Address
First Line : 814 S WASHINGTON ST
Second Line :
City : MOSCOW
State : ID
Zip : 83843-3049
Country : US
Telephone Number : 208-882-0619
Fax Number : 208-882-4774
Provider Business Practice Location Address
First Line : 814 S WASHINGTON ST
Second Line :
City : MOSCOW
State : ID
Zip : 83843-3049
Country : US
Telephone Number : 208-882-0619
Fax Number : 208-882-4774
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 04/27/2006
Last Update Date : 07/08/2007

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