Individual
DANA MILLER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
785 WALL ST, SUITE 200, O FALLON, IL 62269-1959
(618) 367-2194
(618) 726-2024
Mailing address
609 KNIPP DR, MASCOUTAH, IL 62258-1308
(618) 910-7053
Taxonomy
Speciality
Code
Description
License number
State
251S00000X
Community/Behavioral Health Agency
Primary
149.011546
IL
Other
Enumeration date
06/05/2015
Last updated
06/05/2015
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