Provider Demographics
NPI:1780578609
Name:MILLER, JAIDAN MARIE
Entity type:Individual
Prefix:
First Name:JAIDAN
Middle Name:MARIE
Last Name:MILLER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:804 SWANKE STREET
Mailing Address - Street 2:
Mailing Address - City:TIGERTON
Mailing Address - State:WI
Mailing Address - Zip Code:54486
Mailing Address - Country:US
Mailing Address - Phone:715-881-1274
Mailing Address - Fax:
Practice Address - Street 1:710 PARK AVE
Practice Address - Street 2:
Practice Address - City:WAUPACA
Practice Address - State:WI
Practice Address - Zip Code:54981-1956
Practice Address - Country:US
Practice Address - Phone:920-720-2300
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-06-05
Last Update Date:2025-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical