Provider Demographics
NPI:1003917022
Name:MILLER, LINDA LOUISE (MA LP)
Entity Type:Individual
Prefix:
First Name:LINDA
Middle Name:LOUISE
Last Name:MILLER
Suffix:
Gender:F
Credentials:MA LP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2497 7TH AVE E
Mailing Address - Street 2:SUITE 101
Mailing Address - City:NORTH ST PAUL
Mailing Address - State:MN
Mailing Address - Zip Code:55109-2496
Mailing Address - Country:US
Mailing Address - Phone:651-769-6437
Mailing Address - Fax:651-769-6426
Practice Address - Street 1:327 S MARSCHALL RD
Practice Address - Street 2:SUITE 250
Practice Address - City:SHAKOPEE
Practice Address - State:MN
Practice Address - Zip Code:55379-2666
Practice Address - Country:US
Practice Address - Phone:651-769-6500
Practice Address - Fax:651-769-6549
Is Sole Proprietor?:No
Enumeration Date:2006-09-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNLP1267103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical