MEDICARE: KAREN 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	LW00004003	WA

General Provider Information

NPI Number	:	1417948514
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KAREN A MILLER LICSW

Provider Business Mailing Address
First Line	:	275 SE CABOT DR
Second Line	:	SUITE B206
City	:	OAK HARBOR
State	:	WA
Zip	:	98277-3715
Country	:	US
Telephone Number	:	360-679-4551
Fax Number	:	360-679-9341

Provider Business Practice Location Address
First Line	:	275 SE CABOT DR
Second Line	:	SUITE B206
City	:	OAK HARBOR
State	:	WA
Zip	:	98277-3715
Country	:	US
Telephone Number	:	360-679-4551
Fax Number	:	360-679-9341

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

Provider Enumeration Date	:	10/31/2005
Last Update Date	:	07/08/2007

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