| Jennifer L. Miller, Ph.d., Lp, Llc | |
|
110 2nd St S Ste 303 Waite Park MN 56387-1314 | |
| (320) 217-6025 | |
| (320) 774-3005 |
| Full Name | Jennifer L. Miller, Ph.d., Lp, Llc |
|---|---|
| Speciality | Community/Behavioral Health |
| Location | 110 2nd St S Ste 303, Waite Park, Minnesota |
| Authorized Official Name and Position | Jennifer L. Miller (LICENSED PSYCHOLOGIST) |
| Authorized Official Contact | 3202176025 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Jennifer L. Miller, Ph.d., Lp, Llc 110 2nd St. S. Suite #303 Waite Park MN 56387 Ph: (320) 217-6025 | Jennifer L. Miller, Ph.d., Lp, Llc 110 2nd St S Ste 303 Waite Park MN 56387-1314 Ph: (320) 217-6025 |
| NPI Number | 1316253214 |
|---|---|
| Provider Enumeration Date | 08/30/2010 |
| Last Update Date | 07/21/2022 |
| Medicare PECOS PAC ID | 8628261070 |
|---|---|
| Medicare Enrollment ID | O20101019000390 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1316253214 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 251S00000X | Community/behavioral Health | LP 4367 (Minnesota) | Primary |
| Provider Name | Jennifer L Miller |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1366761629 PECOS PAC ID: 3072706431 Enrollment ID: I20101019000436 |
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