MEDICARE: J. MILLER PSYCHOLOGY

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	103TC0700X	Clinical Psychologist

General Provider Information

NPI Number	:	1477179828
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	J. MILLER PSYCHOLOGY

Provider Business Mailing Address
First Line	:	4925 N WINCHESTER AVE APT 2
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60640-6945
Country	:	US
Telephone Number	:	717-413-9444
Fax Number	:

Provider Business Practice Location Address
First Line	:	4925 N WINCHESTER AVE APT 2
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60640-6945
Country	:	US
Telephone Number	:	717-413-9444
Fax Number	:

Authorized Official
Title or Position	:	LICENSED CLINICAL PSYCHOLOGIST
Name	:	DR. JESSICA MILLER
Credential	:	PSYD
Telephone Number	:	717-413-9444

Provider Enumeration Date	:	06/22/2020
Last Update Date	:	06/22/2020

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