Basic Information
| Provider Information | |||||||||
| NPI: | 1902980881 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | MILLER | ||||||||
| FirstName: | KENDRA | ||||||||
| MiddleName: | JEAN | ||||||||
| NamePrefix: | |||||||||
| NameSuffix: | |||||||||
| Credential: | MSW | ||||||||
| OtherOrganizationName: | |||||||||
| OtherOrganizationType: | |||||||||
| OtherLastName: | MILLER | ||||||||
| OtherFirstName: | KENDRA | ||||||||
| OtherMiddleName: | JEAN | ||||||||
| OtherNamePrefix: | MISS | ||||||||
| OtherNameSuffix: | |||||||||
| OtherCredential: | MSW | ||||||||
| OtherLastNameType: | 2 | ||||||||
| Mailing Information | |||||||||
| Address1: | 310 S. CRAPO STREET SUITE 200 | ||||||||
| Address2: | |||||||||
| City: | MT. PLEASANT | ||||||||
| State: | MI | ||||||||
| PostalCode: | 48858 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9897725938 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 310 S. CRAPO STREET SUITE 200 | ||||||||
| Address2: | |||||||||
| City: | MT. PLEASANT | ||||||||
| State: | MI | ||||||||
| PostalCode: | 48858 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9897725938 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/25/2006 | ||||||||
| LastUpdateDate: | 08/29/2017 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| AuthorizedOfficialMiddleName: | |||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 1041C0700X | 6801066601 | MI | Y | Behavioral Health & Social Service Providers | Social Worker | Clinical |
No ID Information.