Provider Demographics
NPI:1952811812
Name:MILLER, JORDYN TAYLOR (LCSW)
Entity Type:Individual
Prefix:
First Name:JORDYN
Middle Name:TAYLOR
Last Name:MILLER
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:JORDYN
Other - Middle Name:TAYLOR
Other - Last Name:MCCARTHY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:760 FOXPOINTE DR
Mailing Address - Street 2:
Mailing Address - City:SYCAMORE
Mailing Address - State:IL
Mailing Address - Zip Code:60178-3290
Mailing Address - Country:US
Mailing Address - Phone:815-748-8334
Mailing Address - Fax:734-243-5506
Practice Address - Street 1:760 FOXPOINTE DR
Practice Address - Street 2:
Practice Address - City:SYCAMORE
Practice Address - State:IL
Practice Address - Zip Code:60178-3290
Practice Address - Country:US
Practice Address - Phone:815-748-8334
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-10-05
Last Update Date:2023-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6802089571104100000X
IL1490233971041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No104100000XBehavioral Health & Social Service ProvidersSocial Worker