Provider Demographics
NPI:1083289557
Name:MILLER, RACHAEL DAWN
Entity Type:Individual
Prefix:
First Name:RACHAEL
Middle Name:DAWN
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 1:6553 N RON RD
Mailing Address - Street 2:
Mailing Address - City:EVANSVILLE
Mailing Address - State:WI
Mailing Address - Zip Code:53536-9795
Mailing Address - Country:US
Mailing Address - Phone:608-558-8491
Mailing Address - Fax:
Practice Address - Street 1:2802 COHO ST STE 203
Practice Address - Street 2:
Practice Address - City:MADISON
Practice Address - State:WI
Practice Address - Zip Code:53713-4521
Practice Address - Country:US
Practice Address - Phone:608-291-7556
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-05-26
Last Update Date:2021-05-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional