Provider Demographics
NPI:1962950717
Name:MILLER, KATHRYN LEE (PHD)
Entity type:Individual
Prefix:
First Name:KATHRYN
Middle Name:LEE
Last Name:MILLER
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4055 S ROUTE 59 FL 1
Mailing Address - Street 2:
Mailing Address - City:NAPERVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:60564-5803
Mailing Address - Country:US
Mailing Address - Phone:872-246-0651
Mailing Address - Fax:
Practice Address - Street 1:4055 S ROUTE 59 FL 1
Practice Address - Street 2:
Practice Address - City:NAPERVILLE
Practice Address - State:IL
Practice Address - Zip Code:60564-5803
Practice Address - Country:US
Practice Address - Phone:872-246-0651
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-09-21
Last Update Date:2025-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL017.010297103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical