Individual
JACKIE L MILLER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LPC
Contact information
Practice address
1517 E HUEBBE PKWY STE A, BELOIT, WI 53511-1795
(608) 291-5891
(608) 713-9040
Mailing address
1517 E HUEBBE PKWY STE A, BELOIT, WI 53511-1795
(608) 291-5891
(608) 713-9040
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
7632-125
WI
101YP2500X
Professional Counselor
Primary
7632-125
WI
376K00000X
Nurse's Aide
NA131596
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
100086806
—
WI
Enumeration date
03/15/2017
Last updated
04/09/2020
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