Miller, Jackie L

Miller, Jackie L is an sole proprietor health care provider with primary practice located at 1517 E Huebbe Pkwy Ste A , Beloit WI 53511-1795. She recently has 3 registered licenses in different health care specialties including Behavioral Health & Social Service Providers / Mental Health, Nursing Service Related Providers / Nurse's Aide, Behavioral Health & Social Service Providers / Professional. Behavioral Health & Social Service Providers / Professional is her primary health care specialty. Miller, Jackie L can be contacted via phone (608) 291-5891.

Contact Information

Primary practice address
1517 E Huebbe Pkwy Ste A Beloit WI 53511-1795
Phone: (608) 291-5891
Fax: (608) 713-9040
Website:
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Health care specialties

SpecialtyCodeLicense #State
Behavioral Health & Social Service Providers / Mental Health 101YM0800X 7632-125 Wisconsin
Nursing Service Related Providers / Nurse's Aide 376K00000X NA131596 Wisconsin
Behavioral Health & Social Service Providers / Professional 101YP2500X 7632-125 Wisconsin

Profile Details

NPI number 1922549567
LBN Legal business name Miller, Jackie L
Credentials Licensed Professional Counselor (LPC)
Entity Individual
Sole proprietor 1 Yes
Enumeration date Mar 15th, 2017
Last updated Apr 9th, 2020 - about 6 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1922549567 NPPES
Wisconsin MEDICAID 100086806

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