Provider Demographics
NPI:1962588616
Name:MILES, KENNETH A (PHD)
Entity type:Individual
Prefix:DR
First Name:KENNETH
Middle Name:A
Last Name:MILES
Suffix:
Gender:M
Credentials:PHD
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Mailing Address - Street 1:MADIGAN ARMY MEDICAL CENTER ATTN: KENNETH A MILES, PH.D
Mailing Address - Street 2:9040 JACKSON AVE
Mailing Address - City:TACOMA
Mailing Address - State:WA
Mailing Address - Zip Code:98431
Mailing Address - Country:US
Mailing Address - Phone:253-968-2310
Mailing Address - Fax:
Practice Address - Street 1:MADIGAN ARMY MEDICAL CENTER ATTN: KENNETH A MILES, PH.D
Practice Address - Street 2:9040 JACKSON AVE
Practice Address - City:TACOMA
Practice Address - State:WA
Practice Address - Zip Code:98431
Practice Address - Country:US
Practice Address - Phone:253-968-2310
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-10-27
Last Update Date:2019-03-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
WA2264103TC2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC2200XBehavioral Health & Social Service ProvidersPsychologistClinical Child & Adolescent