Provider Demographics
NPI:1669679783
Name:MILLER, BROOKE (MSW)
Entity Type:Individual
Prefix:MS
First Name:BROOKE
Middle Name:
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 1:4110 PACIFIC AVE
Mailing Address - Street 2:SUITE 102
Mailing Address - City:FOREST GROVE
Mailing Address - State:OR
Mailing Address - Zip Code:97116-2383
Mailing Address - Country:US
Mailing Address - Phone:503-601-5400
Mailing Address - Fax:503-601-5410
Practice Address - Street 1:4110 PACIFIC AVE
Practice Address - Street 2:SUITE 102
Practice Address - City:FOREST GROVE
Practice Address - State:OR
Practice Address - Zip Code:97116-2383
Practice Address - Country:US
Practice Address - Phone:503-601-5400
Practice Address - Fax:503-601-5410
Is Sole Proprietor?:No
Enumeration Date:2007-07-02
Last Update Date:2014-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAASW 175741041C0700X
ORL47571041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical