Provider Demographics
NPI:1902855364
Name:MILLER, PATRICIA LYNN (PHD)
Entity Type:Individual
Prefix:DR
First Name:PATRICIA
Middle Name:LYNN
Last Name:MILLER
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:350 HOUBOLT ROAD
Mailing Address - Street 2:SUITE 201
Mailing Address - City:JOLIET
Mailing Address - State:IL
Mailing Address - Zip Code:60431-8305
Mailing Address - Country:US
Mailing Address - Phone:815-841-1555
Mailing Address - Fax:815-741-1555
Practice Address - Street 1:350 HOUBOLT ROAD
Practice Address - Street 2:SUITE 201
Practice Address - City:JOLIET
Practice Address - State:IL
Practice Address - Zip Code:60431-8305
Practice Address - Country:US
Practice Address - Phone:815-841-1555
Practice Address - Fax:815-741-1555
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-10
Last Update Date:2013-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL071002555103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
81604OtherCONNECTICUT GENERAL LIFE
7576510OtherAETNA
IL9972011OtherBLUE CROSS BLUE SHIELD
IL9972011OtherBLUE CROSS BLUE SHIELD