Provider Demographics
NPI:1750648994
Name:MILLER, DEBORAH (BCBA)
Entity Type:Individual
Prefix:
First Name:DEBORAH
Middle Name:
Last Name:MILLER
Suffix:
Gender:F
Credentials:BCBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4891 MILLER TRUNK HWY STE 206
Mailing Address - Street 2:
Mailing Address - City:HERMANTOWN
Mailing Address - State:MN
Mailing Address - Zip Code:55811-1563
Mailing Address - Country:US
Mailing Address - Phone:218-720-2945
Mailing Address - Fax:218-720-2947
Practice Address - Street 1:4891 MILLER TRUNK HWY STE 206
Practice Address - Street 2:
Practice Address - City:HERMANTOWN
Practice Address - State:MN
Practice Address - Zip Code:55811-1563
Practice Address - Country:US
Practice Address - Phone:218-720-2945
Practice Address - Fax:218-720-2947
Is Sole Proprietor?:Yes
Enumeration Date:2012-04-12
Last Update Date:2012-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA1-04-1643103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst