Provider Demographics
NPI:1952345480
Name:MILLER, JOCELYN R (PHD)
Entity Type:Individual
Prefix:
First Name:JOCELYN
Middle Name:R
Last Name:MILLER
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2901 HUNTERS TRL
Mailing Address - Street 2:PAUQUETTE CENTER - COMMUNITY SERVIDE ASSOCIATES
Mailing Address - City:PORTAGE
Mailing Address - State:WI
Mailing Address - Zip Code:53901-3403
Mailing Address - Country:US
Mailing Address - Phone:608-742-5518
Mailing Address - Fax:608-742-4087
Practice Address - Street 1:2901 HUNTERS TRL
Practice Address - Street 2:PAUQUETTE CENTER - COMMUNITY SERVICE ASSOCIATES
Practice Address - City:PORTAGE
Practice Address - State:WI
Practice Address - Zip Code:53901-3403
Practice Address - Country:US
Practice Address - Phone:608-742-5518
Practice Address - Fax:608-742-4087
Is Sole Proprietor?:No
Enumeration Date:2006-06-15
Last Update Date:2010-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI1811-057103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI3577OtherDEAN HEALTH INSURANCE
WI39105100Medicaid
R60545Medicare UPIN
WI073074150Medicare PIN