Provider Demographics
NPI:1396146163
Name:MILLER, JEROME
Entity type:Individual
Prefix:
First Name:JEROME
Middle Name:
Last Name:MILLER
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1005 KINGMAN CIR
Mailing Address - Street 2:
Mailing Address - City:DES MOINES
Mailing Address - State:IA
Mailing Address - Zip Code:50311-3519
Mailing Address - Country:US
Mailing Address - Phone:515-865-7783
Mailing Address - Fax:
Practice Address - Street 1:2570 73RD ST
Practice Address - Street 2:
Practice Address - City:URBANDALE
Practice Address - State:IA
Practice Address - Zip Code:50322-4700
Practice Address - Country:US
Practice Address - Phone:515-215-4205
Practice Address - Fax:515-216-4827
Is Sole Proprietor?:No
Enumeration Date:2014-09-10
Last Update Date:2025-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA16018101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)