Provider Demographics
NPI:1922480409
Name:MILLER, JENIFER L (MA)
Entity Type:Individual
Prefix:
First Name:JENIFER
Middle Name:L
Last Name:MILLER
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:HENNEPIN COUNTY EMH CRISIS SERVICES
Mailing Address - Street 2:525 PORTLAND AVENUE, MC 963
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55415
Mailing Address - Country:US
Mailing Address - Phone:612-348-2233
Mailing Address - Fax:
Practice Address - Street 1:HENNEPIN COUNTY EMH CRISIS SERVICES
Practice Address - Street 2:525 PORTLAND AVENUE, MC 963
Practice Address - City:MINNEAPOLIS
Practice Address - State:MN
Practice Address - Zip Code:55415
Practice Address - Country:US
Practice Address - Phone:612-348-2233
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-06-22
Last Update Date:2018-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN121421041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical