MEDICARE: JENNIFER SHERMAN MILLER M.ED.

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	101YM0800X	Mental Health Counselor

General Provider Information

NPI Number	:	1740626415
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JENNIFER SHERMAN MILLER M.ED.

Provider Business Mailing Address
First Line	:	1309 MADISON AVE
Second Line	:
City	:	WINSTON SALEM
State	:	NC
Zip	:	27103-5133
Country	:	US
Telephone Number	:	704-307-3722
Fax Number	:

Provider Business Practice Location Address
First Line	:	2430 REYNOLDA RD
Second Line	:	B
City	:	WINSTON SALEM
State	:	NC
Zip	:	27106-4626
Country	:	US
Telephone Number	:	704-307-3722
Fax Number	:

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

Provider Enumeration Date	:	05/21/2013
Last Update Date	:	04/05/2014

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