MEDICARE: KATHRYN LEE MILLER PHD

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	017.010297	IL

General Provider Information

NPI Number	:	1962950717
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KATHRYN LEE MILLER PHD

Provider Business Mailing Address
First Line	:	4055 S ROUTE 59 FL 1
Second Line	:
City	:	NAPERVILLE
State	:	IL
Zip	:	60564-5803
Country	:	US
Telephone Number	:	872-246-0651
Fax Number	:

Provider Business Practice Location Address
First Line	:	4055 S ROUTE 59 FL 1
Second Line	:
City	:	NAPERVILLE
State	:	IL
Zip	:	60564-5803
Country	:	US
Telephone Number	:	872-246-0651
Fax Number	:

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

Provider Enumeration Date	:	09/21/2016
Last Update Date	:	01/16/2025

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