Provider Demographics
NPI:1568594612
Name:MILLER, KATHRYN EMILY (MSW)
Entity Type:Individual
Prefix:MRS
First Name:KATHRYN
Middle Name:EMILY
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 1:5064 SHINNECOCK HILLS DR NW
Mailing Address - Street 2:
Mailing Address - City:COMSTOCK PARK
Mailing Address - State:MI
Mailing Address - Zip Code:49321-9344
Mailing Address - Country:US
Mailing Address - Phone:616-450-5730
Mailing Address - Fax:
Practice Address - Street 1:2520 EASTERN AVE SE
Practice Address - Street 2:
Practice Address - City:GRAND RAPIDS
Practice Address - State:MI
Practice Address - Zip Code:49507-3633
Practice Address - Country:US
Practice Address - Phone:616-243-1822
Practice Address - Fax:616-243-2069
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-12
Last Update Date:2022-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI68010887871041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical