Provider Demographics
NPI:1164683900
Name:MILLER, JENNY LYNN (LPC)
Entity Type:Individual
Prefix:
First Name:JENNY
Middle Name:LYNN
Last Name:MILLER
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8800 WASHINGTON AVE
Mailing Address - Street 2:100
Mailing Address - City:MOUNT PLEASANT
Mailing Address - State:WI
Mailing Address - Zip Code:53406-3701
Mailing Address - Country:US
Mailing Address - Phone:262-633-3591
Mailing Address - Fax:262-633-2619
Practice Address - Street 1:8800 WASHINGTON AVE
Practice Address - Street 2:100
Practice Address - City:MOUNT PLEASANT
Practice Address - State:WI
Practice Address - Zip Code:53406-3701
Practice Address - Country:US
Practice Address - Phone:262-633-3591
Practice Address - Fax:262-633-2619
Is Sole Proprietor?:No
Enumeration Date:2008-06-24
Last Update Date:2015-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI40051-125101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional