Provider Demographics
NPI:1720187503
Name:WATSON-MILLER, REBECCA JEANNE (PHD)
Entity Type:Individual
Prefix:DR
First Name:REBECCA
Middle Name:JEANNE
Last Name:WATSON-MILLER
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:REBECCA
Other - Middle Name:JEANNE
Other - Last Name:WATSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PHD
Mailing Address - Street 1:3120 W 57TH ST
Mailing Address - Street 2:STE 108
Mailing Address - City:SIOUX FALLS
Mailing Address - State:SD
Mailing Address - Zip Code:57108-3123
Mailing Address - Country:US
Mailing Address - Phone:605-335-5888
Mailing Address - Fax:605-338-9009
Practice Address - Street 1:3130 W 57TH ST STE 108
Practice Address - Street 2:
Practice Address - City:SIOUX FALLS
Practice Address - State:SD
Practice Address - Zip Code:57108
Practice Address - Country:US
Practice Address - Phone:605-335-5888
Practice Address - Fax:605-338-9009
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-21
Last Update Date:2019-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IAIA01018103T00000X
WIWI2526-057103T00000X
WI2526103T00000X
SD473103T00000X
SDSD473103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN382L1WAOtherBLUE CROSS MN PRO FEE
NA9031042561OtherPREFERREDONE
HP48989OtherHEALTHPARTNERS
MN282000500Medicaid
WI39147300Medicaid
MN382L1WAOtherBLUE CROSS MN PRO FEE
WIQ14456WIMedicare UPIN
WIQ14456Medicare UPIN