Provider Demographics
NPI:1093551210
Name:BRIQUELET MILLER, HOLLY K
Entity type:Individual
Prefix:
First Name:HOLLY
Middle Name:K
Last Name:BRIQUELET MILLER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1810 PATRIOT DR
Mailing Address - Street 2:
Mailing Address - City:WAUSAU
Mailing Address - State:WI
Mailing Address - Zip Code:54403-5193
Mailing Address - Country:US
Mailing Address - Phone:715-573-8201
Mailing Address - Fax:
Practice Address - Street 1:227400 RIB MOUNTAIN DR STE D
Practice Address - Street 2:
Practice Address - City:WAUSAU
Practice Address - State:WI
Practice Address - Zip Code:54401-5049
Practice Address - Country:US
Practice Address - Phone:715-301-0667
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-07-08
Last Update Date:2024-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI8002-226101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional