Provider Demographics
NPI:1376667220
Name:MILLER, TAMMY MARIE (BSW)
Entity Type:Individual
Prefix:MS
First Name:TAMMY
Middle Name:MARIE
Last Name:MILLER
Suffix:
Gender:F
Credentials:BSW
Other - Prefix:MS
Other - First Name:TAMMY
Other - Middle Name:MARIE
Other - Last Name:FLUGER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:BSW
Mailing Address - Street 1:N7936 COUNTY ROAD F
Mailing Address - Street 2:
Mailing Address - City:MENOMONIE
Mailing Address - State:WI
Mailing Address - Zip Code:54751-5829
Mailing Address - Country:US
Mailing Address - Phone:715-235-7698
Mailing Address - Fax:
Practice Address - Street 1:808 MAIN ST E
Practice Address - Street 2:
Practice Address - City:MENOMONIE
Practice Address - State:WI
Practice Address - Zip Code:54751-2735
Practice Address - Country:US
Practice Address - Phone:715-232-1116
Practice Address - Fax:715-232-5987
Is Sole Proprietor?:No
Enumeration Date:2007-03-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI6255-120171M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator