Provider Demographics
NPI:1265562037
Name:MILLER, KATHLEEN M (MS LPC CSAC ICS LCPC)
Entity type:Individual
Prefix:
First Name:KATHLEEN
Middle Name:M
Last Name:MILLER
Suffix:
Gender:F
Credentials:MS LPC CSAC ICS LCPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3246 W ROLLINGWOOD DR
Mailing Address - Street 2:
Mailing Address - City:JANESVILLE
Mailing Address - State:WI
Mailing Address - Zip Code:53545-9030
Mailing Address - Country:US
Mailing Address - Phone:608-563-5633
Mailing Address - Fax:608-563-4122
Practice Address - Street 1:3246 W. ROLLINGWOOD DRIVE
Practice Address - Street 2:
Practice Address - City:JANESVILLE
Practice Address - State:WI
Practice Address - Zip Code:53545-9030
Practice Address - Country:US
Practice Address - Phone:608-563-5633
Practice Address - Fax:608-563-4122
Is Sole Proprietor?:No
Enumeration Date:2007-03-07
Last Update Date:2017-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI15139-132101YA0400X
WI15375-135101YA0400X
WI2864125101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)