Provider Demographics
NPI:1043784259
Name:MILLER, JENNA M (EDD)
Entity Type:Individual
Prefix:DR
First Name:JENNA
Middle Name:M
Last Name:MILLER
Suffix:
Gender:F
Credentials:EDD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2749 WALNUT ST APT 512
Mailing Address - Street 2:
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80205-6013
Mailing Address - Country:US
Mailing Address - Phone:217-257-4823
Mailing Address - Fax:
Practice Address - Street 1:400 S COLORADO BLVD STE 400
Practice Address - Street 2:
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80246-1246
Practice Address - Country:US
Practice Address - Phone:303-322-9000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-01-22
Last Update Date:2019-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO0004972103G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103G00000XBehavioral Health & Social Service ProvidersClinical Neuropsychologist