Provider Demographics
NPI:1508193202
Name:MILLER, SANDRA LYNN (MSW)
Entity Type:Individual
Prefix:MS
First Name:SANDRA
Middle Name:LYNN
Last Name:MILLER
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8221 SANDALWOOD DR
Mailing Address - Street 2:
Mailing Address - City:LINCOLN
Mailing Address - State:NE
Mailing Address - Zip Code:68510-2547
Mailing Address - Country:US
Mailing Address - Phone:402-429-1467
Mailing Address - Fax:
Practice Address - Street 1:600 S 70TH ST
Practice Address - Street 2:
Practice Address - City:LINCOLN
Practice Address - State:NE
Practice Address - Zip Code:68510-2451
Practice Address - Country:US
Practice Address - Phone:402-429-1467
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-11-17
Last Update Date:2012-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE842101Y00000X
NE1458101Y00000X
NE268101YA0400X
NE364101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health