Provider Demographics
NPI:1508317470
Name:MILLER, RUTH MARIE (LISW)
Entity Type:Individual
Prefix:
First Name:RUTH
Middle Name:MARIE
Last Name:MILLER
Suffix:
Gender:F
Credentials:LISW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3615 BRIARFIELD BLVD STE B
Mailing Address - Street 2:
Mailing Address - City:MAUMEE
Mailing Address - State:OH
Mailing Address - Zip Code:43537-9381
Mailing Address - Country:US
Mailing Address - Phone:419-386-0031
Mailing Address - Fax:419-315-9973
Practice Address - Street 1:3615 BRIARFIELD BLVD STE B
Practice Address - Street 2:
Practice Address - City:MAUMEE
Practice Address - State:OH
Practice Address - Zip Code:43537-9381
Practice Address - Country:US
Practice Address - Phone:419-386-0031
Practice Address - Fax:419-315-9973
Is Sole Proprietor?:Yes
Enumeration Date:2016-10-17
Last Update Date:2019-12-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHI.19015771041C0700X
251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No251S00000XAgenciesCommunity/Behavioral Health