Provider Demographics
NPI:1083627665
Name:MILLER, JAN M (LCSW)
Entity Type:Individual
Prefix:
First Name:JAN
Middle Name:M
Last Name:MILLER
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:440 SCIENCE DR STE 200
Mailing Address - Street 2:
Mailing Address - City:MADISON
Mailing Address - State:WI
Mailing Address - Zip Code:53711-1064
Mailing Address - Country:US
Mailing Address - Phone:608-238-5176
Mailing Address - Fax:608-238-2727
Practice Address - Street 1:440 SCIENCE DR STE 200
Practice Address - Street 2:
Practice Address - City:MADISON
Practice Address - State:WI
Practice Address - Zip Code:53711-1064
Practice Address - Country:US
Practice Address - Phone:608-238-5176
Practice Address - Fax:608-238-2727
Is Sole Proprietor?:No
Enumeration Date:2006-08-14
Last Update Date:2009-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI2269-123104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI84106Medicare PIN