Provider Demographics
NPI:1518436823
Name:MILLER, EMILY EILEEN (LICSW)
Entity type:Individual
Prefix:
First Name:EMILY
Middle Name:EILEEN
Last Name:MILLER
Suffix:
Gender:F
Credentials:LICSW
Other - Prefix:
Other - First Name:GEORGE
Other - Middle Name:
Other - Last Name:MILLER
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LICSW
Mailing Address - Street 1:4040 S 188TH ST STE 200
Mailing Address - Street 2:
Mailing Address - City:SEATAC
Mailing Address - State:WA
Mailing Address - Zip Code:98188-5070
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:583 VICTORIA ST N
Practice Address - Street 2:
Practice Address - City:SAINT PAUL
Practice Address - State:MN
Practice Address - Zip Code:55104-2762
Practice Address - Country:US
Practice Address - Phone:206-612-0949
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-11-15
Last Update Date:2024-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WALW615379531041C0700X
MN306541041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical