MEDICARE: JACLYN MILLER LMSW

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	104100000X	Social Worker	10027	KS

General Provider Information

NPI Number	:	1366969479
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JACLYN MILLER LMSW

Provider Business Mailing Address
First Line	:	934 N WATER ST
Second Line	:
City	:	WICHITA
State	:	KS
Zip	:	67203-3838
Country	:	US
Telephone Number	:	316-660-7600
Fax Number	:	316-941-5075

Provider Business Practice Location Address
First Line	:	1919 N AMIDON AVE STE 130
Second Line	:
City	:	WICHITA
State	:	KS
Zip	:	67203-2118
Country	:	US
Telephone Number	:	316-660-7675
Fax Number	:	316-832-1571

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

Provider Enumeration Date	:	08/29/2017
Last Update Date	:	08/29/2017

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Directions to “ JACLYN MILLER LMSW” Practice Location

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