Basic Information
| Provider Information | |||||||||
| NPI: | 1598308025 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | MILLER | ||||||||
| FirstName: | MORGAN | ||||||||
| MiddleName: | A | ||||||||
| NamePrefix: | |||||||||
| NameSuffix: | |||||||||
| Credential: | LPC-IT | ||||||||
| OtherOrganizationName: | |||||||||
| OtherOrganizationType: | |||||||||
| OtherLastName: | GROMOWSKI | ||||||||
| OtherFirstName: | MORGAN | ||||||||
| OtherMiddleName: | A | ||||||||
| OtherNamePrefix: | |||||||||
| OtherNameSuffix: | |||||||||
| OtherCredential: | LCP-IT | ||||||||
| OtherLastNameType: | 1 | ||||||||
| Mailing Information | |||||||||
| Address1: | 1100 BERGSLIEN ST | ||||||||
| Address2: | |||||||||
| City: | BALDWIN | ||||||||
| State: | WI | ||||||||
| PostalCode: | 540022600 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7156841111 | ||||||||
| FaxNumber: | 7156841119 | ||||||||
| Practice Location | |||||||||
| Address1: | 1100 BERGSLIEN ST | ||||||||
| Address2: | |||||||||
| City: | BALDWIN | ||||||||
| State: | WI | ||||||||
| PostalCode: | 540022600 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7156841111 | ||||||||
| FaxNumber: | 7156841119 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/28/2019 | ||||||||
| LastUpdateDate: | 10/28/2019 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| AuthorizedOfficialMiddleName: | |||||||||
| AuthorizedOfficialTitleorPosition: | |||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101YP2500X | 4500-226 | WI | Y | Behavioral Health & Social Service Providers | Counselor | Professional |
No ID Information.