Provider Demographics
NPI:1417952292
Name:MILLER, GLENDA M (LCSCW)
Entity Type:Individual
Prefix:MS
First Name:GLENDA
Middle Name:M
Last Name:MILLER
Suffix:
Gender:F
Credentials:LCSCW
Other - Prefix:
Other - First Name:GLENDA
Other - Middle Name:M
Other - Last Name:MAGEE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:211 W 7TH ST
Mailing Address - Street 2:
Mailing Address - City:NEWTON
Mailing Address - State:KS
Mailing Address - Zip Code:67114-1704
Mailing Address - Country:US
Mailing Address - Phone:316-284-2544
Mailing Address - Fax:
Practice Address - Street 1:211 W 7TH ST
Practice Address - Street 2:
Practice Address - City:NEWTON
Practice Address - State:KS
Practice Address - Zip Code:67114-1704
Practice Address - Country:US
Practice Address - Phone:316-284-2544
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2005-06-17
Last Update Date:2015-11-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS21501041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS100395570AMedicaid
KSP27968Medicare UPIN
KS069407Medicare ID - Type Unspecified