Provider Demographics
NPI:1043995897
Name:MILLER, PATRICIA ELAINE
Entity Type:Individual
Prefix:
First Name:PATRICIA
Middle Name:ELAINE
Last Name:MILLER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3650 GLEN OAKS BLVD # 52
Mailing Address - Street 2:
Mailing Address - City:SIOUX CITY
Mailing Address - State:IA
Mailing Address - Zip Code:51104-1546
Mailing Address - Country:US
Mailing Address - Phone:712-222-1459
Mailing Address - Fax:712-222-1460
Practice Address - Street 1:3650 GLEN OAKS BLVD # 52
Practice Address - Street 2:
Practice Address - City:SIOUX CITY
Practice Address - State:IA
Practice Address - Zip Code:51104-1546
Practice Address - Country:US
Practice Address - Phone:712-222-1459
Practice Address - Fax:712-222-1460
Is Sole Proprietor?:No
Enumeration Date:2023-06-20
Last Update Date:2023-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA118575104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker