Provider Demographics
NPI:1902221294
Name:MILLER, CASSANDRA (MED)
Entity Type:Individual
Prefix:
First Name:CASSANDRA
Middle Name:
Last Name:MILLER
Suffix:
Gender:F
Credentials:MED
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1325
Mailing Address - Street 2:
Mailing Address - City:PENDLETON
Mailing Address - State:OR
Mailing Address - Zip Code:97801-0260
Mailing Address - Country:US
Mailing Address - Phone:541-276-5433
Mailing Address - Fax:541-276-8605
Practice Address - Street 1:816 SE 15TH ST
Practice Address - Street 2:
Practice Address - City:PENDLETON
Practice Address - State:OR
Practice Address - Zip Code:97801-3254
Practice Address - Country:US
Practice Address - Phone:541-276-5433
Practice Address - Fax:541-276-8605
Is Sole Proprietor?:Yes
Enumeration Date:2014-02-24
Last Update Date:2014-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health