MEDICARE: MRS. JESSICA MILLER

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number State
1	106S00000X	Behavior Technician
2	247200000X	Other Technician	MI
3	106S00000X	Behavior Technician	MI

General Provider Information

NPI Number	:	1538641220
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. JESSICA MILLER

Provider Business Mailing Address
First Line	:	3471 E GRAND RAPIDS AVE
Second Line	:
City	:	HOWELL
State	:	MI
Zip	:	48843
Country	:	US
Telephone Number	:	800-789-3062
Fax Number	:

Provider Business Practice Location Address
First Line	:	3471 E GRAND RIVER AVE
Second Line	:
City	:	HOWELL
State	:	MI
Zip	:	48843-8552
Country	:	US
Telephone Number	:	734-309-8198
Fax Number	:

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

Provider Enumeration Date	:	08/30/2018
Last Update Date	:	08/01/2023

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