Provider Demographics
NPI:1023492931
Name:MILLER, STEVEN (CSA)
Entity type:Individual
Prefix:
First Name:STEVEN
Middle Name:
Last Name:MILLER
Suffix:
Gender:M
Credentials:CSA
Other - Prefix:
Other - First Name:GUARDIAN
Other - Middle Name:ANGEL
Other - Last Name:CAREGIVERS
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:11022 SE LENORE ST
Mailing Address - Street 2:
Mailing Address - City:HAPPY VALLEY
Mailing Address - State:OR
Mailing Address - Zip Code:97086-8790
Mailing Address - Country:US
Mailing Address - Phone:503-698-2020
Mailing Address - Fax:503-926-9303
Practice Address - Street 1:11022 SE LENORE ST
Practice Address - Street 2:
Practice Address - City:HAPPY VALLEY
Practice Address - State:OR
Practice Address - Zip Code:97086-8790
Practice Address - Country:US
Practice Address - Phone:503-698-2020
Practice Address - Fax:503-926-9303
Is Sole Proprietor?:No
Enumeration Date:2015-07-10
Last Update Date:2015-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR15-2251171W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171W00000XOther Service ProvidersContractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
26-2009073OtherFEDERAL ID NUMBER