Provider Demographics
NPI:1568739720
Name:MILLER, JENNIFER A (LICSW)
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:A
Last Name:MILLER
Suffix:
Gender:F
Credentials:LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:345 N SMITH AVE
Mailing Address - Street 2:
Mailing Address - City:SAINT PAUL
Mailing Address - State:MN
Mailing Address - Zip Code:55102-2346
Mailing Address - Country:US
Mailing Address - Phone:651-220-6479
Mailing Address - Fax:651-220-6393
Practice Address - Street 1:345 N SMITH AVE
Practice Address - Street 2:SOCIAL WORK 70-503
Practice Address - City:ST. PAUL
Practice Address - State:MN
Practice Address - Zip Code:55102-2345
Practice Address - Country:US
Practice Address - Phone:651-220-6479
Practice Address - Fax:651-220-6393
Is Sole Proprietor?:No
Enumeration Date:2011-11-16
Last Update Date:2011-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN133381041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical