Miller, Kimberly

Miller, Kimberly is an individual health care provider with primary practice located at 1541 Annex Rd , Jefferson WI 53549-9803. She recently has 3 registered licenses in different health care specialties including Behavioral Health & Social Service Providers / Addiction (Substance Use Disorder), Behavioral Health & Social Service Providers / Social Worker, Behavioral Health & Social Service Providers / Clinical. Behavioral Health & Social Service Providers / Clinical is her primary health care specialty. Miller, Kimberly can be contacted via phone (920) 674-3105.

Contact Information

Primary practice address
1541 Annex Rd Jefferson WI 53549-9803
Phone: (920) 674-3105
Fax:
Website:
Map and Directions

Health care specialties

SpecialtyCodeLicense #State
Behavioral Health & Social Service Providers / Addiction (Substance Use Disorder) 101YA0400X 18467-130 Wisconsin
Behavioral Health & Social Service Providers / Social Worker 104100000X 131240-121 Wisconsin
Behavioral Health & Social Service Providers / Clinical 1041C0700X 9598-123 Wisconsin

Profile Details

NPI number 1144786658
LBN Legal business name Miller, Kimberly
Credentials LCSW, SAC-IT
Entity Individual
Sole proprietor 1 No
Enumeration date Feb 20th, 2019
Last updated Jan 26th, 2021 - about 5 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 1144786658 NPPES
Wisconsin MEDICAID 42138100

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