Individual
BRANDON KEITH MILLER
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
LSW
Contact information
Practice address
309 W CLARK ST, CHAMPAIGN, IL 61820-4637
(217) 398-9066
(217) 398-9077
Mailing address
403 COMPTON AVE, CHAMPAIGN, IL 61822-7353
(331) 425-5283
Taxonomy
Speciality
Code
Description
License number
State
104100000X
Social Worker
Primary
150.104394
IL
Other
Enumeration date
07/22/2020
Last updated
09/30/2020
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