Provider Demographics
NPI:1144493164
Name:MILLER, JENNIE LYNN (PHD)
Entity type:Individual
Prefix:DR
First Name:JENNIE
Middle Name:LYNN
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:PO BOX 826
Mailing Address - Street 2:913 KING ST.
Mailing Address - City:CHADRON
Mailing Address - State:NE
Mailing Address - Zip Code:69337-0826
Mailing Address - Country:US
Mailing Address - Phone:308-432-6799
Mailing Address - Fax:308-432-6799
Practice Address - Street 1:913 KING ST
Practice Address - Street 2:913 KING ST.
Practice Address - City:CHADRON
Practice Address - State:NE
Practice Address - Zip Code:69337-2629
Practice Address - Country:US
Practice Address - Phone:308-432-6799
Practice Address - Fax:308-432-6799
Is Sole Proprietor?:No
Enumeration Date:2008-04-10
Last Update Date:2008-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE1137101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE10025382300Medicaid