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NPI Code Detail

MEDICARE: DR. KATHRYN BREVARD MILLER PH.D.

MEDICARE: DR. KATHRYN BREVARD 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
1103TC0700XClinical Psychologist4359MN

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1365LOMIOTHERMNBLUECROSSBLUESHIELD
2MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1558305565
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. KATHRYN BREVARD MILLER PH.D.
Provider Business Mailing Address
First Line : 5101 OLSON MEMORIAL HWY
Second Line : SUITE 4004
City : GOLDEN VALLEY
State : MN
Zip : 55422-5149
Country : US
Telephone Number : 763-595-7294
Fax Number : 763-595-7293
Provider Business Practice Location Address
First Line : 5101 OLSON MEMORIAL HWY
Second Line : SUITE 4004
City : GOLDEN VALLEY
State : MN
Zip : 55422-5149
Country : US
Telephone Number : 763-595-7294
Fax Number : 763-595-7293
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/16/2006
Last Update Date : 05/20/2008

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