Provider Demographics
NPI:1174632814
Name:MILLER, CRAIG WILLIAM (MA)
Entity Type:Individual
Prefix:MR
First Name:CRAIG
Middle Name:WILLIAM
Last Name:MILLER
Suffix:
Gender:M
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:530 S WATER ST STE 3
Mailing Address - Street 2:
Mailing Address - City:PLATTEVILLE
Mailing Address - State:WI
Mailing Address - Zip Code:53818-3626
Mailing Address - Country:US
Mailing Address - Phone:563-564-1796
Mailing Address - Fax:
Practice Address - Street 1:530 S WATER ST STE 3
Practice Address - Street 2:
Practice Address - City:PLATTEVILLE
Practice Address - State:WI
Practice Address - Zip Code:53818-3626
Practice Address - Country:US
Practice Address - Phone:608-348-5088
Practice Address - Fax:608-348-3302
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-29
Last Update Date:2023-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA00892101YM0800X
WI3692101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA00892OtherIOWA LICENSE NUMBER
WI3692OtherWISCONSIN LICENSE NUMBER
WI41009900Medicaid