Provider Demographics
NPI:1225316177
Name:MILLER, JENNIFER M (BASW)
Entity Type:Individual
Prefix:MRS
First Name:JENNIFER
Middle Name:M
Last Name:MILLER
Suffix:
Gender:F
Credentials:BASW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:148 ROGERS ST NW
Mailing Address - Street 2:
Mailing Address - City:OLYMPIA
Mailing Address - State:WA
Mailing Address - Zip Code:98502-5363
Mailing Address - Country:US
Mailing Address - Phone:360-878-8248
Mailing Address - Fax:360-489-0402
Practice Address - Street 1:148 ROGERS ST NW
Practice Address - Street 2:
Practice Address - City:OLYMPIA
Practice Address - State:WA
Practice Address - Zip Code:98502-5363
Practice Address - Country:US
Practice Address - Phone:360-878-8248
Practice Address - Fax:360-489-0402
Is Sole Proprietor?:No
Enumeration Date:2011-07-26
Last Update Date:2011-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPENDING101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor