Provider Demographics
NPI:1912640566
Name:MILLER, KORY
Entity type:Individual
Prefix:
First Name:KORY
Middle Name:
Last Name:MILLER
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:KORY
Other - Middle Name:
Other - Last Name:SCHERER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1360 REGENT ST STE 133
Mailing Address - Street 2:
Mailing Address - City:MADISON
Mailing Address - State:WI
Mailing Address - Zip Code:53715-1255
Mailing Address - Country:US
Mailing Address - Phone:608-889-7173
Mailing Address - Fax:
Practice Address - Street 1:5315 WALL ST STE 200
Practice Address - Street 2:
Practice Address - City:MADISON
Practice Address - State:WI
Practice Address - Zip Code:53718-7937
Practice Address - Country:US
Practice Address - Phone:608-889-7173
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-04-20
Last Update Date:2025-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI11621-125101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health