Provider Demographics
NPI:1386665867
Name:MILLER, JILL A (PSYD, HSPP)
Entity Type:Individual
Prefix:DR
First Name:JILL
Middle Name:A
Last Name:MILLER
Suffix:
Gender:F
Credentials:PSYD, HSPP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8521 NORTHCOTE AVE
Mailing Address - Street 2:
Mailing Address - City:MUNSTER
Mailing Address - State:IN
Mailing Address - Zip Code:46321-2025
Mailing Address - Country:US
Mailing Address - Phone:219-923-5176
Mailing Address - Fax:
Practice Address - Street 1:8521 NORTHCOTE AVE
Practice Address - Street 2:
Practice Address - City:MUNSTER
Practice Address - State:IN
Practice Address - Zip Code:46321-2025
Practice Address - Country:US
Practice Address - Phone:219-923-5176
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-21
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN20041765A103TC0700X
IL071006289103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN200437910Medicaid
IN000000296800Medicare UPIN
IN200437910Medicaid