Provider Demographics
NPI:1770859472
Name:MILLER, ELIZABETH KATELYN (MS)
Entity Type:Individual
Prefix:MISS
First Name:ELIZABETH
Middle Name:KATELYN
Last Name:MILLER
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1829 SW 16TH ST
Mailing Address - Street 2:
Mailing Address - City:REDMOND
Mailing Address - State:OR
Mailing Address - Zip Code:97756-3205
Mailing Address - Country:US
Mailing Address - Phone:541-280-4503
Mailing Address - Fax:
Practice Address - Street 1:1829 SW 16TH ST
Practice Address - Street 2:
Practice Address - City:REDMOND
Practice Address - State:OR
Practice Address - Zip Code:97756-3205
Practice Address - Country:US
Practice Address - Phone:541-280-4503
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-03-27
Last Update Date:2012-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR1200004602251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health