Provider Demographics
NPI:1851166250
Name:MILLER, ERIN MICHELLE (BCBA)
Entity Type:Individual
Prefix:MRS
First Name:ERIN
Middle Name:MICHELLE
Last Name:MILLER
Suffix:
Gender:F
Credentials:BCBA
Other - Prefix:MS
Other - First Name:ERIN
Other - Middle Name:MICHELLE
Other - Last Name:COSTIGAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:5809 WOODLAND DR
Mailing Address - Street 2:
Mailing Address - City:WESTERN SPRINGS
Mailing Address - State:IL
Mailing Address - Zip Code:60558-2140
Mailing Address - Country:US
Mailing Address - Phone:618-210-7499
Mailing Address - Fax:
Practice Address - Street 1:5809 WOODLAND DR
Practice Address - Street 2:
Practice Address - City:WESTERN SPRINGS
Practice Address - State:IL
Practice Address - Zip Code:60558-2140
Practice Address - Country:US
Practice Address - Phone:618-210-7499
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-11-16
Last Update Date:2023-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL1-17-26540103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior AnalystGroup - Single Specialty