Provider Demographics
NPI:1629298773
Name:MILLER, DANIELLE LANISE
Entity Type:Individual
Prefix:
First Name:DANIELLE
Middle Name:LANISE
Last Name:MILLER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8126 S KINGSTON AVE
Mailing Address - Street 2:2ND FL.
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60617-1231
Mailing Address - Country:US
Mailing Address - Phone:773-991-3219
Mailing Address - Fax:773-375-3219
Practice Address - Street 1:8126 S KINGSTON AVE
Practice Address - Street 2:2ND FL.
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60617-1231
Practice Address - Country:US
Practice Address - Phone:773-991-3219
Practice Address - Fax:773-375-3219
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL222Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes222Q00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersDevelopmental Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILDM06470202POtherCREDENTIAL NUMBER