Provider Demographics
NPI:1841382850
Name:MILLER, CATHERINE RAE (EDD)
Entity type:Individual
Prefix:
First Name:CATHERINE
Middle Name:RAE
Last Name:MILLER
Suffix:
Gender:F
Credentials:EDD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:606 3RD ST SW
Mailing Address - Street 2:
Mailing Address - City:WILLMAR
Mailing Address - State:MN
Mailing Address - Zip Code:56201-3328
Mailing Address - Country:US
Mailing Address - Phone:320-220-1340
Mailing Address - Fax:
Practice Address - Street 1:513 5TH ST SW
Practice Address - Street 2:
Practice Address - City:WILLMAR
Practice Address - State:MN
Practice Address - Zip Code:56201-3216
Practice Address - Country:US
Practice Address - Phone:320-264-9692
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-09-28
Last Update Date:2023-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNCP2707103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical