MEDICARE: KIRSTEN MILLER

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	180.016930	IL

General Provider Information

NPI Number	:	1801758495
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KIRSTEN MILLER

Provider Business Mailing Address
First Line	:	100 NICHOLAS DR
Second Line	:
City	:	GROVELAND
State	:	IL
Zip	:	61535-9510
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	2000 W PIONEER PKWY STE 14
Second Line	:
City	:	PEORIA
State	:	IL
Zip	:	61615-1882
Country	:	US
Telephone Number	:	309-550-1001
Fax Number	:

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

Provider Enumeration Date	:	12/02/2025
Last Update Date	:	12/02/2025

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Directions to “ KIRSTEN MILLER ” Practice Location

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