Provider Demographics
NPI:1396563334
Name:MILLER, JILL ANN (EDS)
Entity type:Individual
Prefix:MRS
First Name:JILL
Middle Name:ANN
Last Name:MILLER
Suffix:
Gender:F
Credentials:EDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:200 W SOUTH ST
Mailing Address - Street 2:
Mailing Address - City:CENTERVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:47330-1449
Mailing Address - Country:US
Mailing Address - Phone:765-855-5132
Mailing Address - Fax:765-855-5719
Practice Address - Street 1:200 W SOUTH ST
Practice Address - Street 2:
Practice Address - City:CENTERVILLE
Practice Address - State:IN
Practice Address - Zip Code:47330-1449
Practice Address - Country:US
Practice Address - Phone:765-855-5132
Practice Address - Fax:765-855-5719
Is Sole Proprietor?:No
Enumeration Date:2024-09-30
Last Update Date:2024-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN1592554103TS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TS0200XBehavioral Health & Social Service ProvidersPsychologistSchool