Provider Demographics
NPI:1801915426
Name:MILLER, MONICA J (LSW)
Entity type:Individual
Prefix:MS
First Name:MONICA
Middle Name:J
Last Name:MILLER
Suffix:
Gender:F
Credentials:LSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:461 34TH ST S STE C
Mailing Address - Street 2:
Mailing Address - City:FARGO
Mailing Address - State:ND
Mailing Address - Zip Code:58103-2215
Mailing Address - Country:US
Mailing Address - Phone:701-239-7277
Mailing Address - Fax:
Practice Address - Street 1:461 34TH ST S STE C
Practice Address - Street 2:
Practice Address - City:FARGO
Practice Address - State:ND
Practice Address - Zip Code:58103-2215
Practice Address - Country:US
Practice Address - Phone:701-239-7277
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-28
Last Update Date:2017-05-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator
Provider Identifiers
StateIdentifier IDID TypeIssuer
ND027514OtherBLUE CROSS BLUE SHIELD
ND74078Medicaid