Provider Demographics
NPI:1023726379
Name:MILLER, RAE KARIN (M ED)
Entity type:Individual
Prefix:MS
First Name:RAE
Middle Name:KARIN
Last Name:MILLER
Suffix:
Gender:F
Credentials:M ED
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:102 23RD AVE SE STE A
Mailing Address - Street 2:
Mailing Address - City:PUYALLUP
Mailing Address - State:WA
Mailing Address - Zip Code:98372-4501
Mailing Address - Country:US
Mailing Address - Phone:253-987-5561
Mailing Address - Fax:253-987-7223
Practice Address - Street 1:102 23RD AVE SE STE A
Practice Address - Street 2:
Practice Address - City:PUYALLUP
Practice Address - State:WA
Practice Address - Zip Code:98372-4501
Practice Address - Country:US
Practice Address - Phone:253-987-5561
Practice Address - Fax:253-987-7223
Is Sole Proprietor?:No
Enumeration Date:2022-11-07
Last Update Date:2022-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMC.61372793101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
WAMC.61372793OtherWASHINGTON DEPARTMENT OF HEALTH