Provider Demographics
NPI:1811398522
Name:MILLER, KATELYN MARY (MSSW, LISW-S)
Entity Type:Individual
Prefix:MISS
First Name:KATELYN
Middle Name:MARY
Last Name:MILLER
Suffix:
Gender:F
Credentials:MSSW, LISW-S
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:706 THORPE DR
Mailing Address - Street 2:
Mailing Address - City:SANDUSKY
Mailing Address - State:OH
Mailing Address - Zip Code:44870-1624
Mailing Address - Country:US
Mailing Address - Phone:419-357-2492
Mailing Address - Fax:
Practice Address - Street 1:3911 DONAIR DR
Practice Address - Street 2:
Practice Address - City:SANDUSKY
Practice Address - State:OH
Practice Address - Zip Code:44870-5739
Practice Address - Country:US
Practice Address - Phone:419-357-2492
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-09-12
Last Update Date:2022-07-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHS1450660104100000X
OHI.1801022-SUPV1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No104100000XBehavioral Health & Social Service ProvidersSocial Worker