Provider Demographics
NPI:1922552066
Name:LEXI MILLER
Entity Type:Organization
Organization Name:LEXI MILLER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:LICENSED PRACTITIONER
Authorized Official - Prefix:
Authorized Official - First Name:LEXI
Authorized Official - Middle Name:
Authorized Official - Last Name:MILLER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:952-895-5038
Mailing Address - Street 1:55 BIRNAMWOOD DR
Mailing Address - Street 2:
Mailing Address - City:BURNSVILLE
Mailing Address - State:MN
Mailing Address - Zip Code:55337-2977
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:2308 FRIENDSHIP LN
Practice Address - Street 2:
Practice Address - City:BURNSVILLE
Practice Address - State:MN
Practice Address - Zip Code:55337-4217
Practice Address - Country:US
Practice Address - Phone:952-923-0655
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-08-05
Last Update Date:2016-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNM4020252Y00000X
MNX554209453714347C00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes347C00000XTransportation ServicesPrivate Vehicle
No252Y00000XAgenciesEarly Intervention Provider Agency