Shante Monique Miller, CO 61037377

Primary specialty

Student in an Organized Health Care Education/Training ProgramTaxonomy code 390200000X

License

CO61037377 Issued in WA

Practice address

2601 Summit Ave
Everett, WA 98201-3309

Phone

(425) 258-2407

Fax

(425) 339-2601

NPI assigned

Apr 14, 2020

Sex

Female

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Electronic endpoints 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

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

{
    "created_epoch": "1586822400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1624233600000",
    "number": "1639798192",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "500 E FREMONT ST APT B103",
            "city": "MONROE",
            "state": "WA",
            "postal_code": "982722364",
            "telephone_number": "504-417-6938",
            "fax_number": "206-223-1482"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2601 SUMMIT AVE",
            "city": "EVERETT",
            "state": "WA",
            "postal_code": "982013309",
            "telephone_number": "425-258-2407",
            "fax_number": "425-339-2601"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MILLER",
        "first_name": "SHANTE",
        "middle_name": "MONIQUE",
        "credential": "CO 61037377",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2020-04-14",
        "last_updated": "2021-06-21",
        "certification_date": "2021-06-21",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": "WA",
            "license": "CO61037377",
            "primary": true
        },
        {
            "code": "101YA0400X",
            "taxonomy_group": "",
            "desc": "Counselor, Addiction (Substance Use Disorder)",
            "state": "WA",
            "license": "CO61037377",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "dhmosby@evergreenrc.org",
            "affiliation": "N",
            "address_1": "2601 Summit Ave",
            "city": "Everett",
            "state": "WA",
            "country_code": "US",
            "postal_code": "982013309",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

• Lauren Miller
• Marisol Miller, RN
• Nancy Clements Miller, O.T.
• Ryan J Miller, DPT
• Sarah Miller
• Shelly D Miller, RN
• Sherri Louise Miller, MS, CCC-SLP
• Stephanie E. Miller
• Stephanie Lashay Miller
• Steven Roy Miller, MLC , MH, MNLP

• Student in an Organized Health Care Education/Training Program in Everett, WA
• Providers in Everett, WA by specialty
• Student in an Organized Health Care Education/Training Program in Washington

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 21, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.