| Kathryn B. Miller, P.a. | |
|
5101 Olson Memorial Hwy Suite 4004 Golden Valley MN 55422-5149 | |
| (763) 595-7294 | |
| (763) 595-7293 |
| Full Name | Kathryn B. Miller, P.a. |
|---|---|
| Speciality | Psychologist |
| Location | 5101 Olson Memorial Hwy, Golden Valley, Minnesota |
| Authorized Official Name and Position | Kathryn Brevard Miller (PRESIDENT) |
| Authorized Official Contact | 7635957294 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Kathryn B. Miller, P.a. 5101 Olson Memorial Hwy Suite 4004 Golden Valley MN 55422-5149 Ph: (763) 595-7294 | Kathryn B. Miller, P.a. 5101 Olson Memorial Hwy Suite 4004 Golden Valley MN 55422-5149 Ph: (763) 595-7294 |
| NPI Number | 1114969409 |
|---|---|
| Provider Enumeration Date | 06/12/2006 |
| Last Update Date | 05/20/2008 |
| Medicare PECOS PAC ID | 1759456130 |
|---|---|
| Medicare Enrollment ID | O20080819000882 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1114969409 | NPI | - | NPPES |
| 023640000 | Medicaid | MN | |
| 365L0MI | Other | MN | BLUECROSS BLUESHIELD OF MN |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 103TC0700X | Psychologist - Clinical | 4359 (Minnesota) | Primary |
| Provider Name | Kathryn B Miller |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1558305565 PECOS PAC ID: 7517996739 Enrollment ID: I20050809000104 |
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