Provider Demographics
NPI:1033882501
Name:MILLER, STEPHANIE LOUISE (CDCA)
Entity Type:Individual
Prefix:MISS
First Name:STEPHANIE
Middle Name:LOUISE
Last Name:MILLER
Suffix:
Gender:F
Credentials:CDCA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:352 S DOUGLAS AVE
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:OH
Mailing Address - Zip Code:45505-2453
Mailing Address - Country:US
Mailing Address - Phone:937-869-5576
Mailing Address - Fax:
Practice Address - Street 1:352 S DOUGLAS AVE
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:OH
Practice Address - Zip Code:45505-2453
Practice Address - Country:US
Practice Address - Phone:937-869-5576
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-07-29
Last Update Date:2021-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175T00000XOther Service ProvidersPeer Specialist