Provider Demographics
NPI:1457637779
Name:MILLER, JENNA LEANNE
Entity Type:Individual
Prefix:MS
First Name:JENNA
Middle Name:LEANNE
Last Name:MILLER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:JENNA
Other - Middle Name:
Other - Last Name:BARNES
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:3003 ADAMS ST NE APT K17
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87110-8005
Mailing Address - Country:US
Mailing Address - Phone:575-640-1264
Mailing Address - Fax:
Practice Address - Street 1:500 MARQUETTE AVE NW STE 360
Practice Address - Street 2:
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87102-5317
Practice Address - Country:US
Practice Address - Phone:505-557-4656
Practice Address - Fax:505-514-0874
Is Sole Proprietor?:No
Enumeration Date:2011-11-01
Last Update Date:2024-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMM-080471041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical