Individual
JENNESSA ROSE MILLER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
BA
Contact information
Practice address
77 ANTOSKI DRIVE, GALENA, AK 99741
(907) 656-1366
Mailing address
PO BOX 77, GALENA, AK 99741-0077
(907) 656-1366
Taxonomy
Speciality
Code
Description
License number
State
103K00000X
Behavior Analyst
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
4010
—
AK
Enumeration date
05/01/2019
Last updated
05/01/2019
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