Provider Demographics
NPI:1205084209
Name:MILES, KRISTIN LYNN ARNOLD (PSYD)
Entity type:Individual
Prefix:MRS
First Name:KRISTIN
Middle Name:LYNN ARNOLD
Last Name:MILES
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:MS
Other - First Name:KRISTIN
Other - Middle Name:LYNN
Other - Last Name:ARNOLD
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PSYD
Mailing Address - Street 1:11101 W LINCOLN AVE
Mailing Address - Street 2:
Mailing Address - City:WEST ALLIS
Mailing Address - State:WI
Mailing Address - Zip Code:53227-1133
Mailing Address - Country:US
Mailing Address - Phone:414-327-3000
Mailing Address - Fax:
Practice Address - Street 1:11101 W LINCOLN AVE
Practice Address - Street 2:
Practice Address - City:WEST ALLIS
Practice Address - State:WI
Practice Address - Zip Code:53227-1133
Practice Address - Country:US
Practice Address - Phone:414-327-3000
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-09-03
Last Update Date:2012-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI3011-57103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical