Provider Demographics
NPI:1659860567
Name:MILLER, TAISHAWN (MS, BT)
Entity Type:Individual
Prefix:
First Name:TAISHAWN
Middle Name:
Last Name:MILLER
Suffix:
Gender:F
Credentials:MS, BT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7010 HIGHWAY 7
Mailing Address - Street 2:
Mailing Address - City:ST LOUIS PARK
Mailing Address - State:MN
Mailing Address - Zip Code:55426-4223
Mailing Address - Country:US
Mailing Address - Phone:952-814-0207
Mailing Address - Fax:
Practice Address - Street 1:13225 58TH AVE N APT E
Practice Address - Street 2:
Practice Address - City:PLYMOUTH
Practice Address - State:MN
Practice Address - Zip Code:55442-1685
Practice Address - Country:US
Practice Address - Phone:216-978-4668
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-05-07
Last Update Date:2018-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician