Jennifer L. Miller, PH.D., LP, LLC

Primary specialty

Community/Behavioral Health AgencyTaxonomy code 251S00000X

License

LP 4367 Issued in MN

Legal business name

JENNIFER L. MILLER, PH.D., LP, LLC

Practice address

110 2ND St S Ste 303
Waite Park, MN 56387-1314

Phone

(320) 217-6025

Fax

(320) 774-3005

NPI assigned

Aug 30, 2010

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Dr. Jennifer L. Miller, PH.D., LPNPI 1366761629

Title

Licensed Psychologist

Phone

(320) 217-6025

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in MN

Enrollment records 1

Locations

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Jennifer Lynne Miller, PH.D., LP

  • Counseling Psychologist
  • Waite Park, MN
  • NPI 1366761629
  Medicare reassignment NPD Authorized official

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1283126400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1658361600000",
    "number": "1316253214",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "110 2ND ST. S.",
            "address_2": "SUITE #303",
            "city": "WAITE PARK",
            "state": "MN",
            "postal_code": "56387",
            "telephone_number": "320-217-6025"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "110 2ND ST S STE 303",
            "city": "WAITE PARK",
            "state": "MN",
            "postal_code": "563871314",
            "telephone_number": "320-217-6025",
            "fax_number": "320-774-3005"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1306 4 1/2 Ave N",
            "address_purpose": "LOCATION",
            "city": "Sauk Rapids",
            "state": "MN",
            "postal_code": "563792236",
            "country_code": "US",
            "telephone_number": "320-251-2795",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "JENNIFER L. MILLER, PH.D., LP, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2010-08-30",
        "last_updated": "2022-07-21",
        "status": "A",
        "authorized_official_last_name": "MILLER",
        "authorized_official_first_name": "JENNIFER",
        "authorized_official_middle_name": "L.",
        "authorized_official_title_or_position": "LICENSED PSYCHOLOGIST",
        "authorized_official_telephone_number": "320-217-6025",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "PH.D., LP"
    },
    "taxonomies": [
        {
            "code": "251S00000X",
            "taxonomy_group": "",
            "desc": "Community/Behavioral Health",
            "state": "MN",
            "license": "LP 4367",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Community/Behavioral Health Agency in Waite Park, MN
• Providers in Waite Park, MN by specialty
• Community/Behavioral Health Agency in Minnesota

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 21, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.